MEDICARE: VALORIE S HAVES 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	2084P0800X	Psychiatry Physician	ME70203	FL
2	2084P0800X	Psychiatry Physician	MD040980L	PA

General Provider Information

NPI Number	:	1205876075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALORIE S HAVES MD

Provider Business Mailing Address
First Line	:	101 E OLNEY AVE FL 4
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2480
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PENN BLVD FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1476
Country	:	US
Telephone Number	:	215-951-8300
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	03/17/2018

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