Healthcare Provider Details

I. General information

NPI: 1275539066
Provider Name (Legal Business Name): KAREN P HAVERLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 EAST ST
PLAINVILLE CT
06062-2913
US

IV. Provider business mailing address

300 KENSINGTON AVE
NEW BRITAIN CT
06051-3916
US

V. Phone/Fax

Practice location:
  • Phone: 860-747-5766
  • Fax: 860-747-2028
Mailing address:
  • Phone: 860-747-0730
  • Fax: 860-747-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number030435
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: