Provider Demographics
NPI:1710028923
Name:REED P HAAG MD, PC
Entity Type:Organization
Organization Name:REED P HAAG MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-735-0323
Mailing Address - Street 1:360 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2520
Mailing Address - Country:US
Mailing Address - Phone:607-735-0323
Mailing Address - Fax:607-735-0290
Practice Address - Street 1:360 W WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2520
Practice Address - Country:US
Practice Address - Phone:607-735-0323
Practice Address - Fax:607-735-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191829-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0525Medicare PIN
DC8636Medicare ID - Type UnspecifiedRR MEDICARE GROUP #