Provider Demographics
NPI:1114907235
Name:HAYMORE, JOSEPH BAXTER III (MS, ACNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BAXTER
Last Name:HAYMORE
Suffix:III
Gender:M
Credentials:MS, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 GRETCHEN ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1125
Mailing Address - Country:US
Mailing Address - Phone:301-946-2885
Mailing Address - Fax:
Practice Address - Street 1:2101 MEDICAL PARK DR
Practice Address - Street 2:SUITE 305
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4053
Practice Address - Country:US
Practice Address - Phone:301-754-0833
Practice Address - Fax:301-754-0388
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR148158363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
015377D19Medicare ID - Type Unspecified
Q29864Medicare UPIN