Provider Demographics
NPI:1013048388
Name:HAHER, JANE N (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:N
Last Name:HAHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 RAVENS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-8187
Mailing Address - Country:US
Mailing Address - Phone:505-820-0973
Mailing Address - Fax:
Practice Address - Street 1:69 RAVENS RIDGE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-8187
Practice Address - Country:US
Practice Address - Phone:505-820-0973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107976-3174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17382Medicare UPIN
NYJH06349010Medicare ID - Type UnspecifiedMCR PROVIDER #