Provider Demographics
NPI:1174549935
Name:HARRIS, NORMAN R II (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:R
Last Name:HARRIS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 BERNARD DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4357
Mailing Address - Country:US
Mailing Address - Phone:540-776-6979
Mailing Address - Fax:
Practice Address - Street 1:5115 BERNARD DR
Practice Address - Street 2:SUITE 303
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4357
Practice Address - Country:US
Practice Address - Phone:540-776-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012213362086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6901573Medicaid
VAE07129Medicare UPIN