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General NPI Number Information
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NPI Number | 1427194315
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Entity Type | Individual
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Provider Name | MARK STUART HAYWARD PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 4026 WARDS RD STE G1 MEDICAL DEPARTMENT #138
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City | LYNCHBURG
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State | VA
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Zip | 24502-0060
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Country | US
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Telephone | 703-852-7278
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Fax | 703-859-7644
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Provider Business Mailing Address
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Address Line | 2137 LAKESIDE DR STE 100
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City | LYNCHBURG
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State | VA
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Zip | 24501-6808
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Country | US
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Telephone | 703-852-7278
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Fax | 703-859-7644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110002626
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License Number State | VA
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