Individual
LYDIA HAILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4320 SEMINARY RD, ALEXANDRIA HOSPITAL, ALEXANDRIA, VA 22304
(703) 504-3066
(703) 504-3866
Mailing address
20010 CENTURY BLVD, STE 200, GERMANTOWN, MD 20874-1115
(240) 686-2300
(240) 686-2330
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101231495
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005803403
—
VA
Enumeration date
10/25/2005
Last updated
10/08/2008
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