Dr. Tom Child and Adolescent Medicine

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

93244 Issued in NM

Legal business name

DR. TOM CHILD AND ADOLESCENT MEDICINE

Practice address

Los Alamos Medical Center, 3917 West Rd
Suite M250
Los Alamos, NM 87544
UM

Phone

(505) 412-3367

Fax

(505) 662-9200

NPI assigned

Jan 7, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marvel Elizabeth Harrison, PHDNPI 1992003412

Title

Office Manager

Phone

(505) 412-3367

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marvel E. Harrison, PHD

  • Mental Health Counselor
  • Los Alamos, NM
  • NPI 1992003412
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294358400000",
    "number": "1881998664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 SAN ILDEFONSO RD",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875442735",
            "telephone_number": "505-412-3367"
        },
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "LOS ALAMOS MEDICAL CENTER, 3917 WEST RD",
            "address_2": "SUITE M250",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "87544",
            "telephone_number": "505-412-3367",
            "fax_number": "505-662-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. TOM CHILD AND ADOLESCENT MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-07",
        "last_updated": "2011-01-07",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "MARVEL",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-412-3367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "93244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.