Provider Demographics
NPI:1154488088
Name:HAAN, CHARMAINE VINCENT (RD)
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:VINCENT
Last Name:HAAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 GODFREY DR
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-1368
Mailing Address - Country:US
Mailing Address - Phone:508-952-2120
Mailing Address - Fax:
Practice Address - Street 1:84 GODFREY DR
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-1368
Practice Address - Country:US
Practice Address - Phone:508-952-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA355133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALD0172OtherBCBS PROVIDER
MA494470OtherTUFTS ANCILLARY PROVIDER
MAAA43414OtherHARVARD-PILGRIM ANCILLARY
MAVI MT0211Medicare ID - Type Unspecified