Provider Demographics
NPI:1932294774
Name:HAAS, NELSON S (MD)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:S
Last Name:HAAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 PROUTY DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9326
Mailing Address - Country:US
Mailing Address - Phone:802-334-4191
Mailing Address - Fax:802-334-4193
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:802-334-4191
Practice Address - Fax:802-334-4193
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2803Medicaid
VT00058439OtherBLUE SHIELD
VT740214OtherMVP
VTHAVN2803Medicare ID - Type Unspecified
VT00058439OtherBLUE SHIELD