Provider Demographics
NPI:1356352322
Name:HAVERTY, GARY F (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:F
Last Name:HAVERTY
Suffix:
Gender:M
Credentials:DO
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 310
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0310
Mailing Address - Country:US
Mailing Address - Phone:814-677-3060
Mailing Address - Fax:814-677-3016
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1367
Practice Address - Country:US
Practice Address - Phone:814-849-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003196L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE55443Medicare UPIN
PA064566Medicare PIN