Healthcare Provider Details

I. General information

NPI: 1265431779
Provider Name (Legal Business Name): MARTA S. HAYNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NICHOLASVILLE RD
LEXINGTON KY
40503-1431
US

IV. Provider business mailing address

PO BOX 910082
LEXINGTON KY
40591-0082
US

V. Phone/Fax

Practice location:
  • Phone: 502-226-3858
  • Fax: 502-227-5081
Mailing address:
  • Phone: 877-839-9517
  • Fax: 903-531-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number32473
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: