Provider Demographics
NPI:1336170810
Name:HAAK, EDWARD A (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:HAAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05476-1141
Mailing Address - Country:US
Mailing Address - Phone:802-255-5581
Mailing Address - Fax:802-255-5589
Practice Address - Street 1:44 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:RICHFORD
Practice Address - State:VT
Practice Address - Zip Code:05476-1141
Practice Address - Country:US
Practice Address - Phone:802-255-5580
Practice Address - Fax:802-255-5589
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032.0000334207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1001761Medicaid
VTE03541Medicare UPIN
VTVT922501Medicare PIN
VTVT9225Medicare PIN