Healthcare Provider Details

I. General information

NPI: 1689663338
Provider Name (Legal Business Name): MICHAEL T HAYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FOGG RD DEPARTMENT OF NEUROLOGY
SOUTH WEYMOUTH MA
02190-2432
US

IV. Provider business mailing address

111 CYPRESS ST
BROOKLINE MA
02445-6002
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-8448
  • Fax: 781-624-4378
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number70554
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: