Provider Demographics
NPI:1821103839
Name:HAAKENSON, GARY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:HAAKENSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2417 ATRIUM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6673
Mailing Address - Country:US
Mailing Address - Phone:919-781-9555
Mailing Address - Fax:919-781-1070
Practice Address - Street 1:2417 ATRIUM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6673
Practice Address - Country:US
Practice Address - Phone:919-781-9555
Practice Address - Fax:919-781-1070
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC22477207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC37989OtherBCBS OF NC
NC4290905OtherAETNA
NCA4032OtherMEDCOST
NC1622677OtherFIRST HEALTH
3149986OtherCIGNA
07-52517OtherUNITED HEALTHCARE
NC8937989Medicaid
NC4290905OtherAETNA
NC1622677OtherFIRST HEALTH