Basic Information
| Provider Information | |||||||||
| NPI: | 1972730224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEE | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | MICHELLE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9600 BLACKWELL RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013401188 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4125 BRIARGATE PKWY UNIT 350 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809207851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193143333 | ||||||||
| FaxNumber: | 7193143344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2009 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 263154 | MA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VE0102X | DR.0067492 | CO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology |
No ID Information.