Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | D78279 | MD |
NPI | 1083939326 |
---|---|
Provider Name | Jacqueline Harris |
First Address | Baltimore, MD 21205-1888 |
Second Address | Baltimore, MD 21205-1888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2010 |
Last Update Date | 06/12/2019 |