Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 59356 | MA |
NPI | 1548250228 |
---|---|
Provider Name | Dr. Kenan Edward Haver |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
059356 | TUFTS HEALTH PLAN (01) | MA |
110049658A | (05) | MA |
E78539 | (02) | |
J10856 | BCBS MA (01) | MA |
S400170197 | MEDICARE (01) | MA |