Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OT017181 | PA |
NPI | 1003266131 |
---|---|
Provider Name | Allen Russell Harris |
First Address | Narberth, PA 19072-0305 |
Second Address | Newtown Square, PA 19073-3701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 31/08/2020 |