Healthcare Provider Details

I. General information

NPI: 1003003237
Provider Name (Legal Business Name): KAREN VON HAAM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 DAVIS STRAITS
FALMOUTH MA
02540-3909
US

IV. Provider business mailing address

99 DAVIS STRAITS
FALMOUTH MA
02540-3909
US

V. Phone/Fax

Practice location:
  • Phone: 508-540-7423
  • Fax: 508-540-7152
Mailing address:
  • Phone: 508-540-7423
  • Fax: 508-540-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number158961
License Number StateMA

VIII. Authorized Official

Name: DR. KAREN VON HAAM
Title or Position: PRESIDENT
Credential: MD
Phone: 508-540-7423