Provider Demographics
NPI:1700870771
Name:HADDAD, MICHEL GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:GEORGE
Last Name:HADDAD
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 1295
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1295
Mailing Address - Country:US
Mailing Address - Phone:304-323-4320
Mailing Address - Fax:304-323-4333
Practice Address - Street 1:100 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1604
Practice Address - Country:US
Practice Address - Phone:252-522-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35355207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
220017857OtherRAILROAD MEDICARE
NC38005OtherBCBS OF NC
86732OtherMEDCOST
NC8938005Medicaid
NC38005OtherBCBS OF NC
220017857OtherRAILROAD MEDICARE