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Provider Information for 1548250228

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. KENAN EDWARD HAVER M.D.

Gender: MALE

Individual NPI: 1548250228

Calendar   Last Updated:  2020-11-16
  Certification Date:  2020-11-16

Details

Name Value
NPI 1548250228
Enumeration Date 2005-10-25
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE DIVISION OF RESPIRATORY DISEASES
BOSTON, MA 02115-5724
United States

Phone: 617-355-1900 | Fax: 617-730-0246
View Map External Link
Primary Practice Address 300 LONGWOOD AVE DIVISION OF RESPIRATORY DISEASES
BOSTON, MA 02115-5724
United States

Phone: 617-355-1900 | Fax: 617-730-0246
View Map External Link
Secondary Practice Address 55 LAKE AVE N
WORCESTER, MA 01655-0002
United States

Phone: 508-856-4155 | Fax: 508-856-2609
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ 55 LAKE AVE N
WORCESTER, MA 01655-0002
United States
Direct Messaging Address khaver212054@UmassMemorial.direct-ci.com 55 LAKE AVE N
WORCESTER, MA 01655-0002
United States
Other Identifiers
Issuer State Number
Other TUFTS HEALTH PLAN MA 059356
MEDICAID MA 110049658A
Other BCBS MA MA J10856
Other MEDICARE MA S400170197
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080P0214X - Pediatrics Pediatric Pulmonology MA 59356