Healthcare Provider Details

I. General information

NPI: 1023007283
Provider Name (Legal Business Name): SCOTT M HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE TROWBRIDGE ROAD
BOURNE MA
02532
US

IV. Provider business mailing address

25 COMMUNICATION WAY MEDICAL AFFILIATES OF CAPE COD
HYANNIS MA
02601
US

V. Phone/Fax

Practice location:
  • Phone: 508-759-9200
  • Fax: 508-743-0740
Mailing address:
  • Phone: 508-957-8669
  • Fax: 508-957-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number44375
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: