Healthcare Provider Details

I. General information

NPI: 1386718500
Provider Name (Legal Business Name): MARK STEVEN HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 SOUTH RD
BRADFORD VT
05033-8803
US

IV. Provider business mailing address

331 UPPER PLAIN
BRADFORD VT
05033
US

V. Phone/Fax

Practice location:
  • Phone: 802-272-2674
  • Fax:
Mailing address:
  • Phone: 802-222-4722
  • Fax: 802-222-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number006039
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: