Provider Demographics
NPI:1770587198
Name:HAGGERTY, SALLY M (MD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:M
Last Name:HAGGERTY
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 1:204 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6265
Mailing Address - Country:US
Mailing Address - Phone:610-866-4566
Mailing Address - Fax:610-866-3166
Practice Address - Street 1:204 E MARKET ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6265
Practice Address - Country:US
Practice Address - Phone:610-866-4566
Practice Address - Fax:610-866-3166
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015999E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics