Provider Demographics
NPI:1477743201
Name:DR. CHERYL HAAG
Entity Type:Organization
Organization Name:DR. CHERYL HAAG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-572-6070
Mailing Address - Street 1:214 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-1230
Mailing Address - Country:US
Mailing Address - Phone:215-572-6070
Mailing Address - Fax:
Practice Address - Street 1:214 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ORELAND
Practice Address - State:PA
Practice Address - Zip Code:19075-1230
Practice Address - Country:US
Practice Address - Phone:215-572-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002120 L332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28764Medicare UPIN
PA060730Medicare PIN
PA0182760002Medicare NSC
PA110736Medicare PIN