Healthcare Provider Details

I. General information

NPI: 1770608929
Provider Name (Legal Business Name): TONYA TERESE HAILES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 COLUMBIA ROAD NW
WASHINGTON DC
20009-3697
US

IV. Provider business mailing address

1660 COLUMBIA ROAD NW
WASHINGTON DC
20009-3697
US

V. Phone/Fax

Practice location:
  • Phone: 202-328-3717
  • Fax: 202-548-8600
Mailing address:
  • Phone: 202-328-3717
  • Fax: 202-588-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC50611319
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD036199
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: