Healthcare Provider Details

I. General information

NPI: 1700160181
Provider Name (Legal Business Name): MARISA B HAY B.A. M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 HANOVER AVE
RICHMOND VA
23220-3507
US

IV. Provider business mailing address

1803 HANOVER AVE
RICHMOND VA
23220-3507
US

V. Phone/Fax

Practice location:
  • Phone: 804-314-0870
  • Fax:
Mailing address:
  • Phone: 804-314-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: