MEDICARE: DR. MARY HADDAD 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	16992	SC

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

General Provider Information

NPI Number	:	1598722290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY HADDAD M.D.

Provider Business Mailing Address
First Line	:	114 CLUB POINTE DR
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-6313
Country	:	US
Telephone Number	:	864-208-2345
Fax Number	:	864-208-2366

Provider Business Practice Location Address
First Line	:	250 NORTH GROVE MEDICAL PARK DR
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4222
Country	:	US
Telephone Number	:	864-208-2345
Fax Number	:	864-208-2366

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	09/14/2015

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