MEDICARE: DANIEL HAVEMANN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP453110	PA

General Provider Information

NPI Number	:	1194321703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL HAVEMANN MD

Provider Business Mailing Address
First Line	:	15500 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1113
Country	:	US
Telephone Number	:	215-677-8593
Fax Number	:	215-464-7459

Provider Business Practice Location Address
First Line	:	15500 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1113
Country	:	US
Telephone Number	:	215-677-8593
Fax Number	:	215-464-7459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	12/09/2020

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