MEDICARE: DR. KENAN EDWARD HAVER 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	2080P0214X	Pediatric Pulmonology Physician	59356	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	S400170197	OTHER	MA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	059356	OTHER	MA	TUFTS HEALTH PLAN
2	J10856	OTHER	MA	BCBS MA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548250228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENAN EDWARD HAVER M.D.

Provider Business Mailing Address
First Line	:	300 LONGWOOD AVE
Second Line	:	DIVISION OF RESPIRATORY DISEASES
City	:	BOSTON
State	:	MA
Zip	:	02115-5724
Country	:	US
Telephone Number	:	617-355-1900
Fax Number	:	617-730-0246

Provider Business Practice Location Address
First Line	:	300 LONGWOOD AVE
Second Line	:	DIVISION OF RESPIRATORY DISEASES
City	:	BOSTON
State	:	MA
Zip	:	02115-5724
Country	:	US
Telephone Number	:	617-355-1900
Fax Number	:	617-730-0246

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	11/16/2020

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Directions to “ DR. KENAN EDWARD HAVER M.D.” Practice Location

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