Provider Demographics
NPI:1679674907
Name:HAAS, DOUGLAS L (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:HAAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOLGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13329-1318
Mailing Address - Country:US
Mailing Address - Phone:315-429-8065
Mailing Address - Fax:315-429-3195
Practice Address - Street 1:30 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DOLGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13329-1318
Practice Address - Country:US
Practice Address - Phone:315-429-8065
Practice Address - Fax:315-429-3195
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174706-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY085224OtherMOHAWK VALLEY PHYSICANS
NY01108236Medicaid
NY040403006407OtherFIDELIS
NY16-1339507OtherTAX ID #
NY174706-1OtherSTATE LICENSE NUMBER
NY085224OtherMOHAWK VALLEY PHYSICANS
NY51421BMedicare ID - Type Unspecified