Healthcare Provider Details

I. General information

NPI: 1043283492
Provider Name (Legal Business Name): BASIL M HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/10/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3369 STATE ROUTE 100
MACUNGIE PA
18062-9613
US

IV. Provider business mailing address

PO BOX 3012
WILMINGTON DE
19804
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8111
  • Fax:
Mailing address:
  • Phone: 800-456-4629
  • Fax: 302-224-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD424860
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: