Provider Demographics
NPI:1336139591
Name:HAYDOCK, GALE S (MD)
Entity Type:Individual
Prefix:DR
First Name:GALE
Middle Name:S
Last Name:HAYDOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GALE
Other - Middle Name:S
Other - Last Name:HAYDOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 645
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-2368
Practice Address - Fax:617-726-6861
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3011895Medicaid
MAJ05380OtherBCBS MA
MA055052OtherTUFTS HEALTH PLAN
MAJ05380OtherBCBS MA
B74687Medicare UPIN