Provider Demographics
NPI:1902046261
Name:HAYNES, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 DUPONT CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2793
Mailing Address - Country:US
Mailing Address - Phone:513-576-7700
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:1108 NORTHVIEW DR
Practice Address - Street 2:SUITE 1
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1184
Practice Address - Country:US
Practice Address - Phone:937-393-5781
Practice Address - Fax:937-393-5784
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35095089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2224772Medicaid
OHH144670OtherMEDICAIRE PTAN