Provider Demographics
NPI:1669464327
Name:HAEGELE, LINDA A (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:HAEGELE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:9600 ROOSEVELT BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3932
Mailing Address - Country:US
Mailing Address - Phone:215-677-5500
Mailing Address - Fax:215-677-7280
Practice Address - Street 1:9600 ROOSEVELT BLVD STE 301
Practice Address - Street 2:PHYSICIAN ONCOLOGY, LTD
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:215-677-5500
Practice Address - Fax:215-677-7280
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD016271E207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA603382Medicaid
PA603382004Medicaid
PA049448PLAMedicare ID - Type Unspecified
PA603382004Medicaid
PAB34779Medicare UPIN