Provider Demographics
NPI:1922205756
Name:HAYES, NATHAN R (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:R
Last Name:HAYES
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 NORTH ST
Mailing Address - Street 2:MGHA HOSPITALIST PROGRAM
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4974
Mailing Address - Country:US
Mailing Address - Phone:207-872-1651
Mailing Address - Fax:207-872-1743
Practice Address - Street 1:149 NORTH ST
Practice Address - Street 2:MGHA HOSPITALIST PROGRAM
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4974
Practice Address - Country:US
Practice Address - Phone:207-872-1651
Practice Address - Fax:207-872-1743
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432701999Medicaid
ME0005424Medicare PIN
ME000542401Medicare PIN