Healthcare Provider Details

I. General information

NPI: 1902859226
Provider Name (Legal Business Name): ANTHONY HAYWOOD, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 50
ROMNEY WV
26757
US

IV. Provider business mailing address

PO BOX 2030
ROMNEY WV
26757-2030
US

V. Phone/Fax

Practice location:
  • Phone: 304-822-7866
  • Fax:
Mailing address:
  • Phone: 304-822-7866
  • 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: DR. ANTHONY HAYWOOD
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 304-822-7866