Provider Demographics
NPI:1285799585
Name:HARRISON, MARK ALLAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 COLUMBIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3923
Mailing Address - Country:US
Mailing Address - Phone:845-473-1188
Mailing Address - Fax:845-485-8937
Practice Address - Street 1:1 COLUMBIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-473-1188
Practice Address - Fax:845-485-8937
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2018-09-07
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Provider Licenses
StateLicense IDTaxonomies
NY249392207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03137657Medicaid
NY03137657Medicaid