MEDICARE: MR. GREGORY ALAN HAASE 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	171W00000X	Contractor	0101025209	VA
2	207Q00000X	Family Medicine Physician	0101025209	VA
3	261QM1101X	Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center	0101025209	VA
4	261QU0200X	Urgent Care Clinic/Center	0101025209	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	C08384	OTHER	VA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45360	OTHER	VA	ANTHEM BCBS
3	27048	OTHER	VA	SENTARA
4	280152	OTHER		MDIPA

General Provider Information

NPI Number	:	1962556951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY ALAN HAASE MD

Provider Business Mailing Address
First Line	:	1783 UPPER CHELSEA REACH
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1124
Country	:	US
Telephone Number	:	757-481-4088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1856 COLONIAL MEDICAL COURT
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3075
Country	:	US
Telephone Number	:	757-499-9671
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	12/15/2011

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Directions to “ MR. GREGORY ALAN HAASE MD” Practice Location

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