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General NPI Number Information
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NPI Number | 1295840114
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Entity Type | Individual
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Provider Name | MARJORIE HAAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 130 KATE IRELAND DR
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City | HYDEN
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State | KY
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Zip | 41749-9071
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Country | US
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Telephone | 606-672-2341
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Fax | 606-672-5254
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Provider Business Mailing Address
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Address Line | 234 VILLAGE PARK DR
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City | LEBANON
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State | OH
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Zip | 45036-7709
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Country | US
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Telephone | 513-310-8288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 49078
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License Number State | KY
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