Provider Demographics
NPI:1699089169
Name:HARRIS, MARK ALLEN (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8558
Mailing Address - Country:US
Mailing Address - Phone:304-269-8000
Mailing Address - Fax:304-269-8090
Practice Address - Street 1:70 N STURMER ST
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-7403
Practice Address - Country:US
Practice Address - Phone:304-823-2801
Practice Address - Fax:304-823-2703
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV01415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant