Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | OS010577L | PA |
NPI | 1003869256 |
---|---|
Provider Name | Christopher Haines |
First Address | Churchville, PA 18966-1079 |
Second Address | Philadelphia, PA 19134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 28/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012642300001 | (05) | PA |
H79228 | (02) | PA |