Provider Demographics
NPI:1710963491
Name:HAYBRON, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:HAYBRON
Suffix:
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 1:10 MEDICAL PARK
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-3889
Mailing Address - Fax:304-243-8802
Practice Address - Street 1:10 MEDICAL PARK
Practice Address - Street 2:SUITE 101
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-3889
Practice Address - Fax:304-243-8802
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26275208G00000X
PAMD074417L208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018629050001Medicaid
WV2001021000Medicaid
OH2183677Medicaid
WV2001021000Medicaid
F51361Medicare UPIN
PA780002016Medicare PIN
PA049582NKSMedicare PIN
PAP00629766Medicare PIN