Basic Information
| Provider Information | |||||||||
| NPI: | 1457328015 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAAG | ||||||||
| FirstName: | BURRITT | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MEDICAL CENTER DR | ||||||||
| Address2: | STE 404 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137363163 | ||||||||
| FaxNumber: | 4137330206 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE # 404 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137363163 | ||||||||
| FaxNumber: | 4137330206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 218040 | MA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2024420 | 05 | MA | MEDICAID | 4211687-006 | 01 | CIGNA | OTHER | AA609 | 01 | HARVARD PILGRAM HEALTH CA | OTHER | J27065 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 33159 | 01 | HEALTH NEW ENGLAND | OTHER | 3361080 | 01 | AETNA | OTHER |