MEDICARE: CHARLES HADDAD 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	208600000X	Surgery Physician	18896	AZ
2	208600000X	Surgery Physician	MD2013-0238	NM

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346220456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES HADDAD MD

Provider Business Mailing Address
First Line	:	4101 INDIAN SCHOOL RD NE STE 110
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3991
Country	:	US
Telephone Number	:	505-727-7096
Fax Number	:	505-727-7099

Provider Business Practice Location Address
First Line	:	601 DR MARTIN LUTHER KING JR AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3619
Country	:	US
Telephone Number	:	505-727-7096
Fax Number	:	505-727-7099

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	03/26/2020

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Directions to “ CHARLES HADDAD MD” Practice Location

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