Provider Demographics
NPI:1225124415
Name:HAIMES, DAVID L (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:HAIMES
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6600 STATE ROUTE 96
Mailing Address - Street 2:FIVE POINTS CORRECTIONAL FACILITY
Mailing Address - City:ROMULUS
Mailing Address - State:NY
Mailing Address - Zip Code:14541-9560
Mailing Address - Country:US
Mailing Address - Phone:607-869-5111
Mailing Address - Fax:607-869-5031
Practice Address - Street 1:6600 STATE ROUTE 96
Practice Address - Street 2:FIVE POINTS CORRECTIONAL FACILITY
Practice Address - City:ROMULUS
Practice Address - State:NY
Practice Address - Zip Code:14541-9560
Practice Address - Country:US
Practice Address - Phone:607-869-5111
Practice Address - Fax:607-869-5031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002110363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR53738Medicare UPIN