Provider Demographics
NPI:1902212145
Name:NELSON S HAAS MD PC
Entity Type:Organization
Organization Name:NELSON S HAAS MD PC
Other - Org Name:NORTH STAR OCCUPATIONAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-334-9300
Mailing Address - Street 1:1734 CRAWFORD FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-4509
Mailing Address - Country:US
Mailing Address - Phone:802-334-9300
Mailing Address - Fax:802-334-9299
Practice Address - Street 1:1734 CRAWFORD FARM RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-4509
Practice Address - Country:US
Practice Address - Phone:802-334-9300
Practice Address - Fax:802-334-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010304261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2803Medicaid