1144303959 NPI number — ANGELA R HABERFIELD RD, LD, CDE

Table of content: ELENORA P VON MSW, LICSW (NPI 1720304561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144303959 NPI number — ANGELA R HABERFIELD RD, LD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABERFIELD
Provider First Name:
ANGELA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, LD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144303959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
218 DENNIS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLAIRSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43950-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-359-1825
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL PARK
Provider Second Line Business Practice Location Address:
WHEELING HOSPITAL
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-6379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-242-9355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  2082-0495 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 624 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 624 . This is a "WV BOARD OF LICENSED DIETITIANS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 952452 . This is a "COMMISSION ON DIETETIC REGISTRATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2082-0495 . This is a "NATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS" identifier . This identifiers is of the category "OTHER".