Provider Demographics
NPI:1508874793
Name:HAYNES, NADIENE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:NADIENE
Middle Name:ELIZABETH
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 OVERLOOK PL
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4302
Mailing Address - Country:US
Mailing Address - Phone:443-622-8190
Mailing Address - Fax:302-424-4189
Practice Address - Street 1:108 OVERLOOK PLACE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-424-3900
Practice Address - Fax:302-424-4189
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10009885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1508874793Medicaid
DE233838YAEAMedicare PIN