Provider Demographics
NPI:1932109006
Name:HAYAG-THOMAS, LEA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:
Last Name:HAYAG-THOMAS
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:PO BOX 635283
Mailing Address - Street 2:ST. ELIZABETH PHYSICIANS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:200 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3408
Practice Address - Country:US
Practice Address - Phone:859-301-5900
Practice Address - Fax:859-301-5940
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY364952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2637730Medicaid
KY64109051Medicaid
H47395Medicare UPIN
KY64109051Medicaid
P00270233Medicare PIN
KY0687712Medicare PIN