Theodore Harrison Jr., IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

3020 Silver Charm Cir
Suffolk, VA 23435-3343

Phone

(757) 375-5017

NPI assigned

Oct 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1972791218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 SILVER CHARM CIR",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353343",
            "telephone_number": "757-375-5017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 SILVER CHARM CIR",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353343",
            "telephone_number": "757-375-5017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "THEODORE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-11",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luke Douglas Harris, PHARMD
• Roderick Tirell Harris Sr.
• Shawndell Harris
• Thomas Harris
• Yasmine Harris
• April Hartless, NP-C
• Jamie Hartsfield, LPC
• Harvest New Generation Adult Day Health Center
• Tanetta Hassell, LCSW
• Laura Elizabeth Hastings, AGACNP, RN, CWON

• Independent Duty Corpsman in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Independent Duty Corpsman in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; 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.