Provider Demographics
NPI:1871634394
Name:HARRYS PRIMARY CARE LLC
Entity type:Organization
Organization Name:HARRYS PRIMARY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-312-4700
Mailing Address - Street 1:8600 SNOWDEN RIVER PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1982
Mailing Address - Country:US
Mailing Address - Phone:410-312-4700
Mailing Address - Fax:410-312-0400
Practice Address - Street 1:8600 SNOWDEN RIVER PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1982
Practice Address - Country:US
Practice Address - Phone:410-312-4700
Practice Address - Fax:410-312-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD129373OtherAETNA PPO
MD129373OtherAETNA HMO
MDKCC1HAOtherBLUCECROSS OF MARYLAND
MDF991OtherBCBS FEP
MDF991OtherBCBS BLUECHOICE
MD129373OtherAETNA HMO
MDKCC1HAOtherBLUCECROSS OF MARYLAND
MDKCC1HAOtherBLUCECROSS OF MARYLAND