Provider Demographics
NPI:1295314052
Name:HAUGHTON, RENEE (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:HAUGHTON
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 1:235 BRENTMOOR RD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1711
Mailing Address - Country:US
Mailing Address - Phone:860-212-8970
Mailing Address - Fax:
Practice Address - Street 1:1537 BARTLETT LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3696
Practice Address - Country:US
Practice Address - Phone:860-212-8970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTA184579208D00000X
390200000X
CAA184579208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program