1235175910 NPI number — R. HAYES HANLEY JR. M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235175910 NPI number — R. HAYES HANLEY JR. M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HANLEY

Provider First Name:

R.

Provider Middle Name:

HAYES

Provider Name Prefix Text:

Provider Name Suffix Text:

JR.

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1235175910

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/02/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

635 N WASHINGTON HWY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ASHLAND

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

23005-1317

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

804-798-9208

Provider Business Mailing Address Fax Number:

804-798-8108

Provider First Line Business Practice Location Address:

635 N WASHINGTON HWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ASHLAND

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

23005-1317

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

804-798-9208

Provider Business Practice Location Address Fax Number:

804-798-8108

Provider Enumeration Date:

06/21/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  0101027003 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: C05704 . This is a "GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 114642 . This is a "ANTHEM BCBS OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 254784 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 79175 . This is a "SOUTHERN HEALTH SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 110168787 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 110168161 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4063436 . This is a "AETNA LIFE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1533238 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 005811783 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 45900 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4063436 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".