Individual
DIANE D. HARRISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, MPH
Contact information
Practice address
236 PHILIP PL, PHILADELPHIA, PA 19106-3902
(610) 659-3405
Mailing address
236 PHILIP PL, PHILADELPHIA, PA 19106-3902
(610) 659-3405
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD042814E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD042814E
PENNSYLVANIA MEDICAL LICENSE
PA
Enumeration date
03/08/2019
Last updated
03/08/2019
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