Healthcare Provider Details

I. General information

NPI: 1013904515
Provider Name (Legal Business Name): ERIC J HAACKE-GOLDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HAYDENPARK LN STE 300
HENRICO VA
23233-7867
US

IV. Provider business mailing address

3400 HAYDENPARK LN STE 300
HENRICO VA
23233-7867
US

V. Phone/Fax

Practice location:
  • Phone: 804-998-1600
  • Fax: 804-998-1601
Mailing address:
  • Phone: 804-998-1600
  • Fax: 804-323-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101228662
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: