Provider Demographics
NPI:1154488351
Name:HADDAD, GEORGE A (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 DELAWARE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217
Mailing Address - Country:US
Mailing Address - Phone:716-876-3737
Mailing Address - Fax:716-447-0627
Practice Address - Street 1:3800 DELAWARE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217
Practice Address - Country:US
Practice Address - Phone:716-876-3737
Practice Address - Fax:716-447-0627
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0407894OtherIHA
NY00020500901OtherUNIVERA
NY000511495006OtherCOMMUNITY BLUE
F41306Medicare UPIN
NY12125BMedicare ID - Type Unspecified