=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619045564
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAIDER A SARRAF MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 04/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 S WASHINGTON ST EASTON MEMORIAL HOSPITA
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-822-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7651 WOODLAND DR
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-8141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-961-2056
-----------------------------------------------------
Fax | 410-822-9683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | D0059762
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------