MEDICARE: DR. CHARLES MICHAEL HARRISON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	D0041218	MD
2	208VP0000X	Pain Medicine Physician	D0041218	MD

General Provider Information

NPI Number	:	1528156155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MICHAEL HARRISON M.D.

Provider Business Mailing Address
First Line	:	6095 MARSHALEE DR
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6053
Country	:	US
Telephone Number	:	410-379-3599
Fax Number	:

Provider Business Practice Location Address
First Line	:	6095 MARSHALEE DR
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6053
Country	:	US
Telephone Number	:	410-379-3599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	09/25/2009

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