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General NPI Number Information
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NPI Number | 1336170810
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Entity Type | Individual
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Provider Name | EDWARD A HAAK DO
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 44 MAIN ST STE 200
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City | RICHFORD
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State | VT
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Zip | 05476-1141
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Country | US
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Telephone | 802-255-5580
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Fax | 802-255-5589
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Provider Business Mailing Address
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Address Line | 44 MAIN ST STE 200
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City | RICHFORD
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State | VT
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Zip | 05476-1141
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Country | US
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Telephone | 802-255-5581
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Fax | 802-255-5589
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 032.0000334
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License Number State | VT
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