Provider Demographics
NPI:1508930629
Name:HAAR, JAY D (MD PSYCHIATRIST)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:D
Last Name:HAAR
Suffix:
Gender:M
Credentials:MD PSYCHIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S TRIMBLE RD
Mailing Address - Street 2:STE D
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906
Mailing Address - Country:US
Mailing Address - Phone:419-756-9975
Mailing Address - Fax:419-756-1405
Practice Address - Street 1:605 S TRIMBLE RD
Practice Address - Street 2:STE D
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906
Practice Address - Country:US
Practice Address - Phone:419-756-9975
Practice Address - Fax:419-756-1405
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041720H2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000219736OtherANTHEM BCBS OHIO
OHHA0449664Medicare ID - Type Unspecified