Robert Wynne Haeberlein Jr., MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

009794 Issued in ME

Practice address

700 Mount Hope Avenue Suite 601
Bangor, ME 04401-5600

Phone

(207) 942-4653

Fax

(207) 990-4795

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245628800000",
    "number": "1104919901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 MOUNT HOPE AVENUE SUITE 601",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015600",
            "telephone_number": "207-942-4653",
            "fax_number": "207-990-4795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 MOUNT HOPE AVENUE SUITE 601",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015600",
            "telephone_number": "207-942-4653",
            "fax_number": "207-990-4795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAEBERLEIN",
        "first_name": "ROBERT",
        "middle_name": "WYNNE",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2009-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ME",
            "license": "009794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110090000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carley Gurschick, LMSW-CC
• Laura Lee Guzman, RN
• Ashley Gott Haase, DPT
• Brian Hackett
• Holly Haeberlein
• Bethany Haefele, RN
• Samantha Hafford, COTA/L
• Sean Carlton Hagenbuch, MD, FAAP, FACC
• Katie Elizabeth Hager
• John Jay Hagerty, MD

• Dermatology Physician in Bangor, ME
• Providers in Bangor, ME by specialty
• Dermatology Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.