MEDICARE: LINN HAZE CARLETON DO

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	208D00000X	General Practice Physician	OS-003570-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0058090000	OTHER	PA	BLUE SHIELD
2	442012340	OTHER	PA	UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487698395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINN HAZE CARLETON DO

Provider Business Mailing Address
First Line	:	2642 E ONTARIO ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5338
Country	:	US
Telephone Number	:	267-254-8553
Fax Number	:

Provider Business Practice Location Address
First Line	:	2642 E ONTARIO ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5338
Country	:	US
Telephone Number	:	215-425-2133
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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