1114174232 NPI number — DAVID M HARMAN MD LLC

Table of content: (NPI 1114174232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114174232 NPI number — DAVID M HARMAN MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID M HARMAN MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1114174232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45923
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21297-5923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-969-0392
Provider Business Mailing Address Fax Number:
434-455-7172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2108 LANGHORNE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24501-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-385-5600
Provider Business Practice Location Address Fax Number:
434-845-2045
Provider Enumeration Date:
08/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BURTON
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
RCM MANAGER
Authorized Official Telephone Number:
877-969-0392

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  1101002485 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1114174232 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6159160001 . This is a "DURABLE MEDICAL EQUIPMENT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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