Provider Demographics
NPI:1194717736
Name:HARRIS, GLENN D (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:D
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:2150 HERBERT CT
Practice Address - Street 2:ECU PHYSICIANS PEDIATRIC SPECIALTY CARE CLINIC
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3736
Practice Address - Country:US
Practice Address - Phone:252-744-5437
Practice Address - Fax:252-744-1514
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-11-29
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Provider Licenses
StateLicense IDTaxonomies
NC346202080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8939894Medicaid
NC370015146OtherRAILROAD MEDICARE
NC39894OtherBCBS NC
NC39894OtherBCBS NC
NC8939894Medicaid