Healthcare Provider Details

I. General information

NPI: 1376535351
Provider Name (Legal Business Name): ANTHONY HAYWOOD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date: 03/23/2006
Reactivation Date: 04/11/2006

III. Provider practice location address

22347 NORTHWESTERN PIKE
ROMNEY WV
26757-6343
US

IV. Provider business mailing address

PO BOX 97
BAKER WV
26801-0097
US

V. Phone/Fax

Practice location:
  • Phone: 304-822-3838
  • Fax:
Mailing address:
  • Phone: 304-897-5915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1482
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: