Provider Demographics
NPI:1730375494
Name:HENRY D HAYNES, LLC
Entity type:Organization
Organization Name:HENRY D HAYNES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-665-3500
Mailing Address - Street 1:50 TREMONT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2721
Mailing Address - Country:US
Mailing Address - Phone:781-665-3500
Mailing Address - Fax:781-665-1114
Practice Address - Street 1:50 TREMONT ST
Practice Address - Street 2:APT 101
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2721
Practice Address - Country:US
Practice Address - Phone:781-665-3500
Practice Address - Fax:781-665-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30455208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9741992Medicaid
MA9741992Medicaid
MAM13673Medicare PIN