Provider Demographics
NPI:1710159702
Name:PATRICIA J. DANAHER-HAAG
Entity Type:Organization
Organization Name:PATRICIA J. DANAHER-HAAG
Other - Org Name:PATRICIA J DANAHER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DANAHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-778-8627
Mailing Address - Street 1:2658 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-1033
Mailing Address - Country:US
Mailing Address - Phone:716-778-8627
Mailing Address - Fax:716-778-8059
Practice Address - Street 1:2658 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-1033
Practice Address - Country:US
Practice Address - Phone:716-778-8627
Practice Address - Fax:716-778-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02335371Medicaid
NYBA0255Medicare PIN