1386254076 NPI number — TIMIA ROCHELLE ELEAZER HARRIS

Table of content: TIMIA ROCHELLE ELEAZER HARRIS (NPI 1386254076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386254076 NPI number — TIMIA ROCHELLE ELEAZER HARRIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELEAZER HARRIS
Provider First Name:
TIMIA
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1386254076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3605 DORY BROOKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE BEACH
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20732-3865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-771-2896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 BAYSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNDALK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21222-4912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-771-2896
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2020

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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