Provider Demographics
NPI:1275593808
Name:HAIK, NEDIRA E (MD)
Entity Type:Individual
Prefix:
First Name:NEDIRA
Middle Name:E
Last Name:HAIK
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 1:102 BUSINESS WAY
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4593
Mailing Address - Country:US
Mailing Address - Phone:540-886-5777
Mailing Address - Fax:
Practice Address - Street 1:102 BUSINESS WAY
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4593
Practice Address - Country:US
Practice Address - Phone:540-886-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1275593808Medicaid
541663754OtherCVFP, INC
MN882227100Medicaid
VAA104004OtherCVFP, INC MEDICARE
MN882227100Medicaid
F85679Medicare UPIN