Provider Demographics
NPI:1033298526
Name:HAYDU, JOSEPH A JR (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:HAYDU
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-2953
Mailing Address - Country:US
Mailing Address - Phone:540-325-1613
Mailing Address - Fax:
Practice Address - Street 1:1555 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-2953
Practice Address - Country:US
Practice Address - Phone:540-325-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-00079332086S0129X
WAOP000013192086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039731Medicaid
DE019097D36Medicare ID - Type Unspecified
DE1000039731Medicaid