Provider Demographics
NPI:1932108024
Name:ATRIUM OBGYN
Entity Type:Organization
Organization Name:ATRIUM OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:HAAKENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-781-9555
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1035OtherALVAREZ NC LICENSE#
NC1104OtherZIMMERMAN NC LICENSE#
NC40022OtherJB NC LICENSE#
NC28040OtherHENDERSON NC LICENSE#
NC22477OtherHAAKENSON NC LICENSE#
NC89135FAMedicaid
NC8941376Medicaid
NC7989860Medicaid
NC8937989Medicaid
NC1104OtherZIMMERMAN NC LICENSE#
NCS72810Medicare UPIN
NC207173EMedicare ID - Type UnspecifiedHENDERSON MEDICARE#
NC2597632AMedicare ID - Type UnspecifiedJB MEDICARE#
NC2021587Medicare ID - Type UnspecifiedALVAREZ MEDICARE#
NC40022OtherJB NC LICENSE#
NC8941376Medicaid
NC28040OtherHENDERSON NC LICENSE#
NCC84441Medicare UPIN
NC89135FAMedicaid