Provider Demographics
NPI:1245294164
Name:HAUGH, JEFFREY THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:THOMAS
Last Name:HAUGH
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:PO BOX 931
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-0931
Mailing Address - Country:US
Mailing Address - Phone:301-685-3555
Mailing Address - Fax:
Practice Address - Street 1:1110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUITE 228
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21712
Practice Address - Country:US
Practice Address - Phone:301-733-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037485207L00000X, 207LP2900X
PAMD060826L207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD50050095OtherRR MC
MDCA8702OtherRR GRP
MD347081400Medicaid
MD427SMedicare PIN
MD347081400Medicaid
MD426SMedicare PIN