MEDICARE: DR. JAMES ANDREW HAYDU DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5091	VA

General Provider Information

NPI Number	:	1265578611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ANDREW HAYDU DMD

Provider Business Mailing Address
First Line	:	200 LIGON ST # 1860
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23523-1000
Country	:	US
Telephone Number	:	757-494-0454
Fax Number	:	757-494-0745

Provider Business Practice Location Address
First Line	:	200 LIGON ST # 1860
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23523-1000
Country	:	US
Telephone Number	:	757-494-0454
Fax Number	:	757-494-0745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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