MEDICARE: DR. KAREN P HAVERLY M.D.

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	207V00000X	Obstetrics & Gynecology Physician	030435	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	135451	OTHER	CT	WELLCARE MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01030435	OTHER	CT	CIGNA PROV ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	060025	OTHER	CT	HEALTH NET PROV ID
5	060916784-042	OTHER	CT	TRICARE HNFS PROV ID
7	P369881	OTHER	CT	OXFORD PROV ID
8	3043501	OTHER	CT	CONNECTICARE PROV ID
9	912397	OTHER	CT	HEALTH NET REF ID
10	010030435CT01	OTHER	CT	BCBS N BCFP PROV ID
11	1255448155	OTHER	CT	GHMC NPI ID
12	482028	OTHER	CT	AETNA PROV ID

General Provider Information

NPI Number	:	1275539066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN P HAVERLY M.D.

Provider Business Mailing Address
First Line	:	300 KENSINGTON AVE
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06051-3916
Country	:	US
Telephone Number	:	860-747-0730
Fax Number	:	860-747-2028

Provider Business Practice Location Address
First Line	:	184 EAST ST
Second Line	:
City	:	PLAINVILLE
State	:	CT
Zip	:	06062-2913
Country	:	US
Telephone Number	:	860-747-5766
Fax Number	:	860-747-2028

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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