Provider Demographics
NPI:1720191919
Name:HARMON, DOUGLASS MONROE JR (DO)
Entity type:Individual
Prefix:
First Name:DOUGLASS
Middle Name:MONROE
Last Name:HARMON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 FOX CHASE DR
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8611
Mailing Address - Country:US
Mailing Address - Phone:724-816-2977
Mailing Address - Fax:855-476-8911
Practice Address - Street 1:997 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2807
Practice Address - Country:US
Practice Address - Phone:412-502-5124
Practice Address - Fax:855-476-8911
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013439207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2332121Medicaid
OH000000032022OtherBCBS
OH000000291736OtherBCBS
P00115646OtherRR MCR
OH2332121Medicaid
OH4081925Medicare PIN
OHH60975Medicare UPIN