Provider Demographics
NPI:1265430375
Name:HADDAD, HANI N (MD)
Entity type:Individual
Prefix:
First Name:HANI
Middle Name:N
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1088
Mailing Address - Country:US
Mailing Address - Phone:413-781-8290
Mailing Address - Fax:413-732-7628
Practice Address - Street 1:3550 MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1089
Practice Address - Country:US
Practice Address - Phone:413-781-8290
Practice Address - Fax:413-732-7628
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38466207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2046288Medicaid
MA2046288Medicaid
MAN51650Medicare PIN