Healthcare Provider Details

I. General information

NPI: 1083802656
Provider Name (Legal Business Name): TREVIA HAYDEN, MD LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 THOMAS JOHNSON DR SUITE 102
FREDERICK MD
21702-4379
US

IV. Provider business mailing address

97 THOMAS JOHNSON DR SUITE 102
FREDERICK MD
21702-4379
US

V. Phone/Fax

Practice location:
  • Phone: 301-846-0434
  • Fax: 301-846-0143
Mailing address:
  • Phone: 301-846-0434
  • Fax: 301-846-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberD0053096
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0053096
License Number StateMD

VIII. Authorized Official

Name: DR. TREVIA FINESE HAYDEN
Title or Position: PSYCHIATRIST/DOCTOR
Credential: M.D.
Phone: 301-846-0434