1427194315 NPI number — MARK STUART HAYWARD PHYSICIAN ASSISTANT

Table of content: MARK STUART HAYWARD PHYSICIAN ASSISTANT (NPI 1427194315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427194315 NPI number — MARK STUART HAYWARD PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYWARD
Provider First Name:
MARK
Provider Middle Name:
STUART
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1427194315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2137 LAKESIDE DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24501-6808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-852-7278
Provider Business Mailing Address Fax Number:
703-859-7644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4026 WARDS RD STE G1
Provider Second Line Business Practice Location Address:
MEDICAL DEPARTMENT #138
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24502-0060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-852-7278
Provider Business Practice Location Address Fax Number:
703-859-7644
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  0110002626 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1057265 . This is a "NCCPA (PA-C)" identifier . This identifiers is of the category "OTHER".




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