Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD419523 | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD419523 | PA |
NPI | 1326066523 |
---|---|
Provider Name | Dr. Christopher A. Haines |
First Address | Philadelphia, PA 19107-4414 |
Second Address | Philadelphia, PA 19107-4414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 18/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001967264 | (05) | PA |
0054267 | (05) | NJ |