Provider Demographics
NPI:1720058308
Name:HAITH, LINWOOD R JR (MD)
Entity Type:Individual
Prefix:
First Name:LINWOOD
Middle Name:R
Last Name:HAITH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1350 EDGMONT AVE
Mailing Address - Street 2:STE 1500
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3962
Mailing Address - Country:US
Mailing Address - Phone:610-619-7400
Mailing Address - Fax:610-872-4015
Practice Address - Street 1:ONE MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 241
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-619-7400
Practice Address - Fax:610-872-4015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2018-11-07
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Provider Licenses
StateLicense IDTaxonomies
PAMD021047E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008325810005Medicaid
C30334Medicare UPIN
PA0008325810005Medicaid