Provider Demographics
NPI:1932186038
Name:HADDAD, DEBRA (NP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:HADDAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3407
Mailing Address - Country:US
Mailing Address - Phone:508-799-9000
Mailing Address - Fax:508-753-3733
Practice Address - Street 1:107 LINCOLN ST
Practice Address - Street 2:ADCARE HOSPITAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2401
Practice Address - Country:US
Practice Address - Phone:508-799-9000
Practice Address - Fax:508-753-3733
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHA NP4335Medicare ID - Type Unspecified