Individual
LINN HAZE CARLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2642 E ONTARIO ST, PHILADELPHIA, PA 19134-5338
(215) 425-2133
Mailing address
2642 E ONTARIO ST, PHILADELPHIA, PA 19134-5338
(267) 254-8553
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OS-003570-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0058090000
BLUE SHIELD
PA
05
—
0124383600
—
PA
01
—
442012340
UNITED HEALTHCARE
PA
Enumeration date
06/15/2006
Last updated
07/08/2007
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