Healthcare Provider Details

I. General information

NPI: 1225200132
Provider Name (Legal Business Name): TIMOTHY J HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COLLEGE STREET
RICHMOND VA
23298-0058
US

IV. Provider business mailing address

PO BOX 980058 401 COLLEGE STREET
RICHMOND VA
23298-0058
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7232
  • Fax:
Mailing address:
  • Phone: 804-828-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101255843
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: