Healthcare Provider Details

I. General information

NPI: 1235132655
Provider Name (Legal Business Name): KARL FREDERICK HAFNER M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 N 2ND ST
FULTON NY
13069-1254
US

IV. Provider business mailing address

98 N 2ND ST
FULTON NY
13069-1254
US

V. Phone/Fax

Practice location:
  • Phone: 315-598-1220
  • Fax: 315-598-7541
Mailing address:
  • Phone: 315-598-1220
  • Fax: 315-598-7541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number150265
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: