Provider Demographics
NPI:1366575128
Name:VANHAASTEREN, LORETTA (MD)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:VANHAASTEREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 W NEW HOPE RD
Mailing Address - Street 2:APT C6
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-7567
Mailing Address - Country:US
Mailing Address - Phone:828-442-4520
Mailing Address - Fax:
Practice Address - Street 1:532 W NEW HOPE RD
Practice Address - Street 2:APT C6
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-7567
Practice Address - Country:US
Practice Address - Phone:828-442-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891113HMedicaid
NC7300933OtherAETNA
NC1193618OtherCIGNA
NC1193618OtherCIGNA
NC2249124HMedicare PIN
D27885Medicare UPIN