Healthcare Provider Details

I. General information

NPI: 1689120453
Provider Name (Legal Business Name): ORVILLE HAYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HICKORY RD #681
WASHINGTON GROVE MD
20880
US

IV. Provider business mailing address

113 HICKORY RD #681
WASHINGTON GROVE MD
20880
US

V. Phone/Fax

Practice location:
  • Phone: 301-355-8066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number102161
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: