Healthcare Provider Details

I. General information

NPI: 1700589207
Provider Name (Legal Business Name): THOMAS L HAUPT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 05/12/2024
Certification Date: 05/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST FL 2
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

80 DEKALB AVE APT 19D
BROOKLYN NY
11201-5455
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4401
  • Fax: 510-535-7313
Mailing address:
  • Phone: 303-217-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: