Basic Information
| Provider Information | |||||||||
| NPI: | 1700018777 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBOR FAMILY MEDICINE, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1915 S 16TH ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284016610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103438191 | ||||||||
| FaxNumber: | 9102518006 | ||||||||
| Practice Location | |||||||||
| Address1: | 1915 S 16TH ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284016610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103438191 | ||||||||
| FaxNumber: | 9102518006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2009 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | CONSTANCE | ||||||||
| AuthorizedOfficialMiddleName: | LEIGH | ||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY PRACTICE PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9103438191 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200300311 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.