Healthcare Provider Details

I. General information

NPI: 1134376247
Provider Name (Legal Business Name): DONALD HARRISON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 10/09/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8023 RITCHIE HWY. SUITE B
PASADENA MD
21122-4998
US

IV. Provider business mailing address

8023 RITCHIE HWY. SUITE B
PASADENA MD
21122-4998
US

V. Phone/Fax

Practice location:
  • Phone: 240-437-3861
  • Fax: 240-609-0345
Mailing address:
  • Phone: 240-437-3861
  • Fax: 240-609-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006078
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01510
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: