Provider Demographics
NPI:1497483721
Name:HAYES, STEPHEN PEARCE
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PEARCE
Last Name:HAYES
Suffix:
Gender:M
Credentials:
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 1980
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-1980
Mailing Address - Country:US
Mailing Address - Phone:757-446-5869
Mailing Address - Fax:
Practice Address - Street 1:700 W OLNEY RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1607
Practice Address - Country:US
Practice Address - Phone:757-446-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA355850627013Medicaid