1457357246 NPI number — DR. PETER J HARRIS M.D.

Table of content: DR. PETER J HARRIS M.D. (NPI 1457357246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457357246 NPI number — DR. PETER J HARRIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
PETER
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457357246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 KENSINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06051-3916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-747-5766
Provider Business Mailing Address Fax Number:
860-747-2028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 EAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06062-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-747-5766
Provider Business Practice Location Address Fax Number:
860-747-2028
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  037834 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2151393 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 369674 . This is a "WELLCARE MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001378349 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010037834CT02 . This is a "BCBS N BCFP PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004215324 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01037834 . This is a "CIGNA PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 037834 . This is a "CONNECTICARE ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1255448155 . This is a "GHMC GROUP NPI ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1853296 . This is a "OXFORD PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0V5889 . This is a "HEALTH NET PROV ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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