Provider Demographics
NPI:1780642983
Name:HALEY, EILEEN C (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:C
Last Name:HALEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:2 ESSEX DR
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2902
Practice Address - Country:US
Practice Address - Phone:978-532-2800
Practice Address - Fax:978-977-4492
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-06-08
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Provider Licenses
StateLicense IDTaxonomies
MA45101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA045101OtherTUFTS
MA5630495-001OtherCIGNA
MA3214508OtherAETNA
MA64494OtherHARVARD PILGRIM
MA0016138OtherNEIGHBORHOOD HEALTH
MA3094871Medicaid
MAJ12026OtherBLUE CROSS
MA045101OtherTUFTS
MA5630495-001OtherCIGNA