Basic Information
| Provider Information | |||||||||
| NPI: | 1275539066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAVERLY | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 KENSINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060513916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607470730 | ||||||||
| FaxNumber: | 8607472028 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 EAST ST | ||||||||
| Address2: | |||||||||
| City: | PLAINVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060622913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607475766 | ||||||||
| FaxNumber: | 8607472028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 030435 | CT | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 004196095 | 01 | CT | GHMC GRP MEDICAID ID | OTHER | 01030435 | 01 | CT | CIGNA PROV ID | OTHER | 001304352 | 05 | CT | MEDICAID | 060025 | 01 | CT | HEALTH NET PROV ID | OTHER | 060916784-042 | 01 | CT | TRICARE HNFS PROV ID | OTHER | 135451 | 01 | CT | WELLCARE MEDICARE | OTHER | P369881 | 01 | CT | OXFORD PROV ID | OTHER | 3043501 | 01 | CT | CONNECTICARE PROV ID | OTHER | 912397 | 01 | CT | HEALTH NET REF ID | OTHER | 010030435CT01 | 01 | CT | BCBS N BCFP PROV ID | OTHER | 1255448155 | 01 | CT | GHMC NPI ID | OTHER | 482028 | 01 | CT | AETNA PROV ID | OTHER |