Provider Demographics
NPI:1558342790
Name:VON HAAM, KAREN ELISABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ELISABETH
Last Name:VON HAAM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:270 TEATICKET HWY
Mailing Address - Street 2:STE 1A
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5671
Mailing Address - Country:US
Mailing Address - Phone:508-540-7423
Mailing Address - Fax:508-540-7152
Practice Address - Street 1:270 TEATICKET HWY
Practice Address - Street 2:STE 1A
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5671
Practice Address - Country:US
Practice Address - Phone:508-540-7423
Practice Address - Fax:508-540-7152
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2013-09-16
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Provider Licenses
StateLicense IDTaxonomies
MA158961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9720791Medicaid
MAM21135Medicare PIN
MA9720791Medicaid