MEDICARE: DR. DAVID SAMUEL HADEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101045572	VA

General Provider Information

NPI Number	:	1316989718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SAMUEL HADEN M.D.

Provider Business Mailing Address
First Line	:	5505 INDIAN RIVER RD
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5252
Country	:	US
Telephone Number	:	757-420-9573
Fax Number	:	757-420-5649

Provider Business Practice Location Address
First Line	:	5505 INDIAN RIVER RD
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5252
Country	:	US
Telephone Number	:	757-420-9573
Fax Number	:	757-420-5649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/08/2007

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