1821057001 NPI number — DR. MARTIN C HARRIS DPM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821057001 NPI number — DR. MARTIN C HARRIS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
MARTIN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1821057001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 WILKINS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02762-2257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-695-1444
Provider Business Mailing Address Fax Number:
508-695-6169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 WILKENS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02762-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-695-1444
Provider Business Practice Location Address Fax Number:
508-695-6169
Provider Enumeration Date:
03/17/2006

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: 213E00000X , with the licence number:  1521 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 188 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 71242 . This is a "BCBS WOONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y70622 . This is a "BLUE SHIELD OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0334928 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000007042 . This is a "RHODE ISLAND BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 203049 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2702001 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0009562 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 13038 . This is a "HANCOCK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0012071 . This is a "WELFARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1521 . This is a "REGISTERED POD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 188 . This is a "REGISTERED POD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 33086 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 715018 . This is a "TUFTS IPA 13" identifier . This identifiers is of the category "OTHER".




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