Healthcare Provider Details

I. General information

NPI: 1790990356
Provider Name (Legal Business Name): STEPHEN HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

IV. Provider business mailing address

1 ELLIOT WAY
MANCHESTER NH
03103-3502
US

V. Phone/Fax

Practice location:
  • Phone: 603-663-1800
  • Fax: 603-668-4303
Mailing address:
  • Phone: 603-663-1800
  • Fax: 603-668-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number242794
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number14839
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: