Provider Demographics
NPI:1548250228
Name:HAVER, KENAN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:KENAN
Middle Name:EDWARD
Last Name:HAVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:DIVISION OF RESPIRATORY DISEASES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-1900
Mailing Address - Fax:617-730-0246
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:DIVISION OF RESPIRATORY DISEASES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-1900
Practice Address - Fax:617-730-0246
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2020-11-16
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Provider Licenses
StateLicense IDTaxonomies
MA593562080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA059356OtherTUFTS HEALTH PLAN
MAJ10856OtherBCBS MA
MA110049658AMedicaid
MAS400170197OtherMEDICARE
MAS400170197OtherMEDICARE
MAJ10856OtherBCBS MA