Provider Demographics
NPI:1407126014
Name:HAAS, GLENN EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:EDWARD
Last Name:HAAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MARTIN CT
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1856
Mailing Address - Country:US
Mailing Address - Phone:215-584-7627
Mailing Address - Fax:
Practice Address - Street 1:17 MARTIN CT
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1856
Practice Address - Country:US
Practice Address - Phone:215-584-7627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003745L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine