Provider Demographics
NPI:1073763934
Name:HAVERKAMP, MIRIAM R (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:R
Last Name:HAVERKAMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1001
Mailing Address - Country:US
Mailing Address - Phone:617-636-7001
Mailing Address - Fax:
Practice Address - Street 1:TUFTS MEDICAL CENTER
Practice Address - Street 2:800 WASHINGTON STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine