=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720191919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOUGLASS MONROE HARMON JR. DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 09/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 997 N MAIN ST
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15301-2807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-502-5124
-----------------------------------------------------
Fax | 855-476-8911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1505 FOX CHASE DR
-----------------------------------------------------
City | SEWICKLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15143-8611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-816-2977
-----------------------------------------------------
Fax | 855-476-8911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | OS013439
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------