Provider Demographics
NPI:1134254980
Name:DEBORAH G. HARRIS, D.O., INC.
Entity type:Organization
Organization Name:DEBORAH G. HARRIS, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-373-3731
Mailing Address - Street 1:103 SWANEY CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-8002
Mailing Address - Country:US
Mailing Address - Phone:740-373-3731
Mailing Address - Fax:740-373-3731
Practice Address - Street 1:103 SWANEY CT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-8002
Practice Address - Country:US
Practice Address - Phone:740-373-3731
Practice Address - Fax:740-373-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007687H174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2471954Medicaid
WV3810001592Medicaid
OH9343541Medicare PIN
OH2471954Medicaid