Provider Demographics
NPI:1366580086
Name:HARRIS, CARLINE NANCY (MD)
Entity type:Individual
Prefix:DR
First Name:CARLINE
Middle Name:NANCY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:116 CLINTON ST STE 1FF
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4204
Mailing Address - Country:US
Mailing Address - Phone:718-834-7663
Mailing Address - Fax:718-834-7664
Practice Address - Street 1:116 CLINTON ST STE 1FF
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4204
Practice Address - Country:US
Practice Address - Phone:718-834-7663
Practice Address - Fax:718-834-7664
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY119937208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78844Medicare UPIN