Provider Demographics
NPI:1821080722
Name:HAVERLY, ROBERT F (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:F
Last Name:HAVERLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W 24TH ST
Mailing Address - Street 2:STE 401
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2665
Mailing Address - Country:US
Mailing Address - Phone:814-455-7591
Mailing Address - Fax:814-454-1467
Practice Address - Street 1:311 W 24TH ST
Practice Address - Street 2:STE 401
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2665
Practice Address - Country:US
Practice Address - Phone:814-455-7591
Practice Address - Fax:814-454-1467
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066518L207W00000X
OH35075600H207W00000X
NY19556601207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005255861OtherBC/BS OF WNY
4079161OtherHEALTHAMERICA
00020522701OtherUNIVERA/SENIOR CHOICE
217384OtherUPMC
OH35075600HOtherOH NUMBER
PAHA36471OtherHIGHMARK
PA0017358500001Medicaid
NY19556601OtherNY NUMBER
586322OtherAETNA
0810702OtherINDEPENDANT HEALTH
PAMD066518LOtherPA NUMBER
PAMD066518LOtherPA NUMBER
217384OtherUPMC
OHHA4061661Medicare ID - Type Unspecified
586322OtherAETNA
0810702OtherINDEPENDANT HEALTH