Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | MD020500E | PA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD020500E | PA |
Y | 208D00000X | General Practice Physician | MD020500E | PA |
NPI | 1053358887 |
---|---|
Provider Name | Dr. Craig T Haytmanek |
First Address | Fountain Hill, PA 18015-1171 |
Second Address | Fountain Hill, PA 18015-1171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 06/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006092320001 | (05) | PA |