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General NPI Number Information
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NPI Number | 1598875361
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Entity Type | Individual
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Provider Name | MARTHA HELEN HAILE M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 440 SAINT MICHAELS DR
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City | SANTA FE
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State | NM
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Zip | 87505-7602
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Country | US
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Telephone | 410-925-3594
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Fax |
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Provider Business Mailing Address
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Address Line | 145 AVENIDA FRIJOLES
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City | SANTA FE
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State | NM
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Zip | 87507-3411
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Country | US
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Telephone | 410-925-3594
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D35928
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G46967
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | MD2016-0040
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License Number State | NM
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