Provider Demographics
NPI:1033107016
Name:HAAG, MATTHEW JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:HAAG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 AIRPORT GARDENS ROAD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9529
Mailing Address - Country:US
Mailing Address - Phone:606-487-7503
Mailing Address - Fax:606-439-6927
Practice Address - Street 1:115 SUMMERS HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-5172
Practice Address - Country:US
Practice Address - Phone:304-466-2918
Practice Address - Fax:304-466-2917
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003468Medicaid
WV001764617OtherBC/BS
WV187682OtherANTHEM BC/BS
WV313828OtherCARELINK
WVP00265300OtherRAILROAD MEDICARE
WV7280480OtherAETNA
WV313828OtherCARELINK
WVP00265300OtherRAILROAD MEDICARE
WV511837Medicare Oscar/Certification
WVH87280Medicare UPIN
WVHA2026551Medicare PIN