Provider Demographics
NPI:1427387372
Name:HABER, MERYL HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:MERYL
Middle Name:HAROLD
Last Name:HABER
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 1:8464 E CHARTER OAK DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5315
Mailing Address - Country:US
Mailing Address - Phone:480-951-5041
Mailing Address - Fax:480-951-5041
Practice Address - Street 1:8464 E CHARTER OAK DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5315
Practice Address - Country:US
Practice Address - Phone:480-951-5041
Practice Address - Fax:480-951-5941
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.036895207ZP0102X
AZ26406207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL18909Medicare UPIN