Provider Demographics
NPI:1568420586
Name:HAYES, RICHARD D JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:HAYES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 6TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1265
Mailing Address - Country:US
Mailing Address - Phone:304-744-4532
Mailing Address - Fax:304-744-3219
Practice Address - Street 1:312 6TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1265
Practice Address - Country:US
Practice Address - Phone:304-744-4532
Practice Address - Fax:304-744-3219
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055473000Medicaid
1495438001OtherCIGNA
4280085OtherAETNA
0414943Medicare ID - Type Unspecified
WV0055473000Medicaid