Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 2001-01555 | NC |
NPI | 1245320969 |
---|---|
Provider Name | Bradford Harris |
First Address | Baltimore, MD 21209-4545 |
Second Address | Baltimore, MD 21209-4545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 03/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
801211301 | (05) | MD |