Provider Demographics
NPI:1427199827
Name:HAAG, REED P (MD)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:P
Last Name:HAAG
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 1:722 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2435
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2099
Practice Address - Street 1:450 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1043
Practice Address - Country:US
Practice Address - Phone:585-558-4189
Practice Address - Fax:585-382-1863
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191829-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01274735Medicaid
NY01274735Medicaid
NYCC0642Medicare ID - Type UnspecifiedINDIVIDUAL ID