Provider Demographics
NPI:1275539066
Name:HAVERLY, KAREN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:P
Last Name:HAVERLY
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 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-747-0730
Mailing Address - Fax:860-747-2028
Practice Address - Street 1:184 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2913
Practice Address - Country:US
Practice Address - Phone:860-747-5766
Practice Address - Fax:860-747-2028
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030435207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004196095OtherGHMC GRP MEDICAID ID
CT01030435OtherCIGNA PROV ID
CT001304352Medicaid
CT060025OtherHEALTH NET PROV ID
CT060916784-042OtherTRICARE HNFS PROV ID
CT135451OtherWELLCARE MEDICARE
CTP369881OtherOXFORD PROV ID
CT3043501OtherCONNECTICARE PROV ID
CT912397OtherHEALTH NET REF ID
CT010030435CT01OtherBCBS N BCFP PROV ID
CT1255448155OtherGHMC NPI ID
CT482028OtherAETNA PROV ID
E41437Medicare UPIN
CT01030435OtherCIGNA PROV ID
CT001304352Medicaid