Provider Demographics
NPI:1538340237
Name:HAYDAR, VICTORIA E (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:E
Last Name:HAYDAR
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 1:10251 SW 72ND ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2957
Mailing Address - Country:US
Mailing Address - Phone:305-279-1975
Mailing Address - Fax:305-274-9263
Practice Address - Street 1:10251 SW 72ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2957
Practice Address - Country:US
Practice Address - Phone:305-279-1975
Practice Address - Fax:305-274-9263
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54293Medicare UPIN
FL34063Medicare PIN