Healthcare Provider Details

I. General information

NPI: 1487780078
Provider Name (Legal Business Name): HAYA ILANA MAYMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 MAIN ST BLDG 1/SUITE 4
MEDFIELD MA
02052-2043
US

IV. Provider business mailing address

266 MAIN ST BLDG 1/SUITE 4/PO BOX 469
MEDFIELD MA
02052-2043
US

V. Phone/Fax

Practice location:
  • Phone: 508-359-8141
  • Fax:
Mailing address:
  • Phone: 508-359-8141
  • Fax: 508-359-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60221
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: