Provider Demographics
NPI:1730384710
Name:HARRISON, MARK D (ACA,NBC-HIS)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:HARRISON
Suffix:
Gender:M
Credentials:ACA,NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N HANSON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3134
Mailing Address - Country:US
Mailing Address - Phone:410-822-1070
Mailing Address - Fax:410-822-7780
Practice Address - Street 1:18 N HANSON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3134
Practice Address - Country:US
Practice Address - Phone:410-822-1070
Practice Address - Fax:410-822-7780
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD654316237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD607209-01OtherMEMBER NO.