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General NPI Number Information
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NPI Number | 1396926143
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Entity Type | Organization
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Legal Business Name | KEVIN C HARRISON, DO PC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 9460 AMBERDALE DRIVE SUITE C
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City | RICHMOND
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State | VA
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Zip | 23236
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Country | US
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Telephone | 804-276-2470
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Fax | 804-276-2473
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Provider Business Mailing Address
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Address Line | 9460 AMBERDALE DRIVE SUITE C
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City | RICHMOND
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State | VA
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Zip | 23236
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Country | US
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Telephone | 804-276-2470
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Fax | 804-276-2473
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | DR. KEVIN CHARLES HARRISON
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Credential | D.O.
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Telephone | 804-276-2470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102-032395
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0102-201098
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0102201098
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License Number State | VA
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