Basic Information
| Provider Information | |||||||||
| NPI: | 1184734360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | PETER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 SHERMAN DR | ||||||||
| Address2: | |||||||||
| City: | ST JOHNSBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058199811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023343504 | ||||||||
| FaxNumber: | 8023343281 | ||||||||
| Practice Location | |||||||||
| Address1: | 82 MAPLE STREET | ||||||||
| Address2: | |||||||||
| City: | ISLAND POND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027234300 | ||||||||
| FaxNumber: | 8027234544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0420007993 | VT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 042.0007993 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8000217 | 01 | VT | LADIES FIRST | OTHER | 810628 | 01 | VT | MVP | OTHER | 3008260 | 05 | NH | MEDICAID | 110137555 | 01 | VT | RAILROAD MEDICARE | OTHER | 00028804 | 01 | VT | BLUE SHIELD | OTHER | 0009470 | 05 | VT | MEDICAID |