Provider Demographics
NPI:1598724817
Name:HAUPTMAN FAMILY HEALTH CENTER PC
Entity type:Organization
Organization Name:HAUPTMAN FAMILY HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARRET
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAUPTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-564-4880
Mailing Address - Street 1:2601 PENNSYVANIA AVENUE
Mailing Address - Street 2:UNIT C6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3212
Mailing Address - Country:US
Mailing Address - Phone:215-564-4880
Mailing Address - Fax:215-564-4890
Practice Address - Street 1:2601 PENNSYVANIA AVENUE
Practice Address - Street 2:UNIT C6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3212
Practice Address - Country:US
Practice Address - Phone:215-564-4880
Practice Address - Fax:215-564-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002602L207R00000X
PADC8616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty