Healthcare Provider Details

I. General information

NPI: 1720053358
Provider Name (Legal Business Name): CRAIG S HAYEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 BLUE RIDGE AVE
BEDFORD VA
24523-2604
US

IV. Provider business mailing address

134 ELON RD
MADISON HEIGHTS VA
24572-2536
US

V. Phone/Fax

Practice location:
  • Phone: 434-929-1400
  • Fax:
Mailing address:
  • Phone: 434-455-2480
  • Fax: 434-455-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101056480
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: