Provider Demographics
NPI:1427065838
Name:HUFFMAN, HAROLD EZRA (M D)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:EZRA
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SYLVAN DR.
Mailing Address - Street 2:P. O. BOX 197
Mailing Address - City:HINTON
Mailing Address - State:VA
Mailing Address - Zip Code:22831-0197
Mailing Address - Country:US
Mailing Address - Phone:540-867-5242
Mailing Address - Fax:540-867-9381
Practice Address - Street 1:12 SYLVAN DR.
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:VA
Practice Address - Zip Code:22831-0197
Practice Address - Country:US
Practice Address - Phone:540-867-5242
Practice Address - Fax:540-867-9381
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101017953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5622905Medicaid
VA5622905Medicaid