Provider Demographics
NPI:1922241546
Name:HAVERTY, THOMAS PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PATRICK
Last Name:HAVERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:PATRICK
Other - Last Name:HAVERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2015 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1310
Mailing Address - Country:US
Mailing Address - Phone:908-740-3800
Mailing Address - Fax:908-740-5002
Practice Address - Street 1:2015 GALLOPING HILL RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1310
Practice Address - Country:US
Practice Address - Phone:908-740-3800
Practice Address - Fax:908-740-5002
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05678500207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology