Provider Demographics
NPI:1760417208
Name:HA, EILEEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:H
Last Name:HA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 110187
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0187
Mailing Address - Country:US
Mailing Address - Phone:907-562-1996
Mailing Address - Fax:907-562-2295
Practice Address - Street 1:3260 PROVIDENCE DR
Practice Address - Street 2:SUITE 422
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4615
Practice Address - Country:US
Practice Address - Phone:907-561-0044
Practice Address - Fax:907-561-5478
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK50892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD50891Medicaid