Individual
DR. GLENN D HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2150 HERBERT CT, ECU PHYSICIANS PEDIATRIC SPECIALTY CARE CLINIC, GREENVILLE, NC 27834-3736
(252) 744-5437
(252) 744-1514
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
(252) 744-3253
(252) 744-3194
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
34620
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370015146
RAILROAD MEDICARE
NC
01
—
39894
BCBS NC
NC
05
—
8939894
—
NC
Enumeration date
08/19/2005
Last updated
11/29/2011
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