Provider Demographics
NPI:1821088105
Name:HALEY, DEBORAH ANN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:HALEY
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HORACE RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2316
Mailing Address - Country:US
Mailing Address - Phone:617-489-7696
Mailing Address - Fax:
Practice Address - Street 1:32 HORACE RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2316
Practice Address - Country:US
Practice Address - Phone:617-489-7696
Practice Address - Fax:617-489-7696
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3207650Medicaid
MA3207650OtherBCBS MA
MA152323OtherTUFTS HEALTH PLAN
MA3207650Medicaid
MAA22241Medicare ID - Type Unspecified