Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 158242 | MA |
N | 208000000X | Pediatrician | 158242 | MA |
NPI | 1770546855 |
---|---|
Provider Name | Dr. David J Harris |
First Address | Auburndale, MA 02466-1013 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 25/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108138 | (05) | MA |