Provider Demographics
NPI:1356644645
Name:HAAS, MEGHAN FRANCES (DO)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:FRANCES
Last Name:HAAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 USF MAGNOLIA DR
Mailing Address - Street 2:MAIL STOP: MRC-SCM
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:MAIL STOP: MRC-SCM
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:570-449-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100255810Medicaid
IN201327040 (KOHMG)Medicaid
KYP01257031OtherRAILROAD MEDICARE
KYK110421 (KOHMG)Medicare PIN
KYK110420Medicare PIN
IN201327040 (KOHMG)Medicaid