Provider Demographics
NPI:1114010345
Name:HARRIS, SUSAN R (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:SCARBOROUGH MANOR 3N1
Mailing Address - City:SCARBOROUGH
Mailing Address - State:NY
Mailing Address - Zip Code:10510-9207
Mailing Address - Country:US
Mailing Address - Phone:718-829-1900
Mailing Address - Fax:718-409-8977
Practice Address - Street 1:MMG - BRONX EAST
Practice Address - Street 2:2300 WESTCHESTER AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:718-829-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine