Individual
NATHAN B HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
335 BRIGHTON AVE, SUITE 200, PORTLAND, ME 04102-2363
(207) 662-8600
(207) 662-8668
Mailing address
301C US ROUTE 1, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA742
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010416156
CIGNA
—
01
—
0378600001
DMERC
—
01
—
041374
ANTHEM
—
01
—
100294000
USPS
—
01
—
1044480
AETNA
—
05
—
261270099
—
ME
01
—
970026451
RR MEDICARE
—
Enumeration date
10/25/2005
Last updated
08/14/2012
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