Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 34620 | NC |
NPI | 1194717736 |
---|---|
Provider Name | Dr. Glenn D Harris |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-3736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 29/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370015146 | RAILROAD MEDICARE (01) | NC |
39894 | BCBS NC (01) | NC |
8939894 | (05) | NC |
F15032 | (02) | NC |