Healthcare Provider Details

I. General information

NPI: 1548581457
Provider Name (Legal Business Name): CHARLES RASHID HARRIS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST UH-1814
SYRACUSE NY
13210-2342
US

IV. Provider business mailing address

110 S BROAD ST APT 4
SACKETS HARBOR NY
13685-4104
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5136
  • Fax:
Mailing address:
  • Phone: 773-520-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number279028
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: