MEDICARE: HOWARD COURTENAY HARRISON JR. MD

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	0101045401	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37200	OTHER	VA	SENTARA/OPTIMA
2	461500	OTHER	VA	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	541595397	OTHER	VA	MID ATLANTIC SOLUTIONS
5	541595397010	OTHER	VA	TRICARE
6	541595397	OTHER	VA	VIRGINIA HEALTH NETWORK
7	541595397	OTHER	VA	PRIVATE HEALTHCARE SYSTEM
8	541595397	OTHER	VA	AETNA

General Provider Information

NPI Number	:	1700850310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOWARD COURTENAY HARRISON JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 7068
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-0068
Country	:	US
Telephone Number	:	757-496-9020
Fax Number	:	757-481-0638

Provider Business Practice Location Address
First Line	:	1168 FIRST COLONIAL RD
Second Line	:	SUITE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2426
Country	:	US
Telephone Number	:	757-496-9020
Fax Number	:	757-481-0638

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	04/12/2010

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