MEDICARE: DR. JULIETTE NEDAH HARRIS 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	207Q00000X	Family Medicine Physician	64464	CT

General Provider Information

NPI Number	:	1962889337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIETTE NEDAH HARRIS M.D.

Provider Business Mailing Address
First Line	:	4200 HOUMA BLVD
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70006-2970
Country	:	US
Telephone Number	:	805-298-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 FLAT ROCK PL
Second Line	:
City	:	WESTBROOK
State	:	CT
Zip	:	06498-3585
Country	:	US
Telephone Number	:	860-358-3640
Fax Number	:

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

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	01/10/2020

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