Individual
JEFFREY HAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
400 W 7TH ST, FREDERICK, MD 21701-4506
(240) 566-3500
Mailing address
8243 BLACK HAW CT, FREDERICK, MD 21701-3200
(301) 631-1831
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110002154
VA
363A00000X
Physician Assistant
Primary
C0003197
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00272236
RAILROAD MEDICARE
VA
Enumeration date
05/12/2006
Last updated
05/22/2008
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