Healthcare Provider Details

I. General information

NPI: 1952397523
Provider Name (Legal Business Name): CHARLES I HAFFAJEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE CARDIOVASCULAR MEDICINE
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE CARDIOVASCULAR MEDICINE
BOSTON MA
02115-2907
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-7521
  • Fax: 617-632-7533
Mailing address:
  • Phone: 617-632-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMH40601
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: