Provider Demographics
NPI:1356302319
Name:HALEY, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:HALEY
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:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:NEW IPSWICH
Mailing Address - State:NH
Mailing Address - Zip Code:03071-0259
Mailing Address - Country:US
Mailing Address - Phone:603-878-1092
Mailing Address - Fax:603-924-3569
Practice Address - Street 1:821 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:NEW IPSWICH
Practice Address - State:NH
Practice Address - Zip Code:03071-3841
Practice Address - Country:US
Practice Address - Phone:603-878-1092
Practice Address - Fax:603-924-3569
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002442Medicaid
NH30002442Medicaid
NH30002442Medicaid