Healthcare Provider Details

I. General information

NPI: 1144303959
Provider Name (Legal Business Name): ANGELA R HABERFIELD RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK WHEELING HOSPITAL
WHEELING WV
26003-6379
US

IV. Provider business mailing address

218 DENNIS LN
SAINT CLAIRSVILLE OH
43950-1607
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-9355
  • Fax:
Mailing address:
  • Phone: 740-359-1825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number624
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2082-0495
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: