Provider Demographics
NPI:1316021819
Name:HAYES MEDICAL CENTER PA
Entity Type:Organization
Organization Name:HAYES MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-719-6470
Mailing Address - Street 1:1332 LONDONTOWN BLVD
Mailing Address - Street 2:115 A&B
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6587
Mailing Address - Country:US
Mailing Address - Phone:410-719-6470
Mailing Address - Fax:410-719-6472
Practice Address - Street 1:1332 LONDONTOWN BLVD
Practice Address - Street 2:115 A&B
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6587
Practice Address - Country:US
Practice Address - Phone:410-719-6470
Practice Address - Fax:410-719-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD786431100Medicaid
MD4143Medicare ID - Type Unspecified