Provider Demographics
NPI:1952397523
Name:HAFFAJEE, CHARLES I (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:I
Last Name:HAFFAJEE
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 1:330 BROOKLINE AVE
Mailing Address - Street 2:CARDIOVASCULAR MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-2907
Mailing Address - Country:US
Mailing Address - Phone:617-632-7582
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:CARDIOVASCULAR MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-632-7521
Practice Address - Fax:617-632-7533
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAMH40601207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2053594Medicaid
A67452Medicare UPIN
MA2053594Medicaid