Provider Demographics
NPI:1417093675
Name:HAVERAN, LIAM
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:
Last Name:HAVERAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMP STREET
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3007
Mailing Address - Country:US
Mailing Address - Phone:506-775-1984
Mailing Address - Fax:508-790-1897
Practice Address - Street 1:100 CAMP STREET
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3007
Practice Address - Country:US
Practice Address - Phone:506-775-1984
Practice Address - Fax:508-790-1897
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222680208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery