Provider Demographics
NPI:1457328015
Name:HAAG, BURRITT L III (MD)
Entity Type:Individual
Prefix:DR
First Name:BURRITT
Middle Name:L
Last Name:HAAG
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2 MEDICAL CENTER DR
Mailing Address - Street 2:STE 404
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1272
Mailing Address - Country:US
Mailing Address - Phone:413-736-3163
Mailing Address - Fax:413-733-0206
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:SUITE # 404
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-736-3163
Practice Address - Fax:413-733-0206
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218040208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2024420Medicaid
4211687-006OtherCIGNA
AA609OtherHARVARD PILGRAM HEALTH CA
J27065OtherBLUE CROSS BLUE SHIELD
33159OtherHEALTH NEW ENGLAND
3361080OtherAETNA
MAA36208Medicare PIN
3361080OtherAETNA