Provider Demographics
NPI:1376535351
Name:HAYWOOD, ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:HAYWOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2030
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-2030
Mailing Address - Country:US
Mailing Address - Phone:304-822-7866
Mailing Address - Fax:304-822-7503
Practice Address - Street 1:RT 50
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-2030
Practice Address - Country:US
Practice Address - Phone:304-822-7866
Practice Address - Fax:304-822-7503
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2021-03-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
WV1482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0046150000Medicaid
WV0046150000Medicaid