Basic Information
| Provider Information | |||||||||
| NPI: | 1457357246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 KENSINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060513916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607475766 | ||||||||
| FaxNumber: | 8607472028 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 EAST ST | ||||||||
| Address2: | |||||||||
| City: | PLAINVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060622913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607475766 | ||||||||
| FaxNumber: | 8607472028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 037834 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2151393 | 01 | CT | CIGNA PROVIDER ID | OTHER | 369674 | 01 | CT | WELLCARE MEDICARE | OTHER | 001378349 | 05 | CT | MEDICAID | 010037834CT02 | 01 | CT | BCBS N BCFP PROV ID | OTHER | 004215324 | 05 | CT | MEDICAID | 01037834 | 01 | CT | CIGNA PROV ID | OTHER | 037834 | 01 | CT | CONNECTICARE ID | OTHER | 1255448155 | 01 | CT | GHMC GROUP NPI ID | OTHER | P1853296 | 01 | CT | OXFORD PROV ID | OTHER | 0V5889 | 01 | CT | HEALTH NET PROV ID | OTHER |