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NPI Code Detail

MEDICARE: DR. CHARLTON P HAERTER MD

MEDICARE: DR. CHARLTON P HAERTER 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
1207R00000XInternal Medicine Physician31842AZ
2208M00000XHospitalist Physician31842AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598758336
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLTON P HAERTER MD
Provider Business Mailing Address
First Line : 9225 N 3RD ST
Second Line : SUITE 300
City : PHOENIX
State : AZ
Zip : 85020-2439
Country : US
Telephone Number : 602-445-0751
Fax Number : 602-424-8128
Provider Business Practice Location Address
First Line : 250 E DUNLAP AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-2825
Country : US
Telephone Number : 602-445-0751
Fax Number : 602-424-8128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2005
Last Update Date : 05/03/2022

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Directions to “ DR. CHARLTON P HAERTER MD” Practice Location

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