Provider Demographics
NPI:1750371159
Name:HALEY, DAVID H (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:HALEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MILLTOWN RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4027
Mailing Address - Country:US
Mailing Address - Phone:302-998-0178
Mailing Address - Fax:302-999-0700
Practice Address - Street 1:1601 MILLTOWN RD
Practice Address - Street 2:SUITE 24
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4027
Practice Address - Country:US
Practice Address - Phone:302-998-0178
Practice Address - Fax:302-999-0700
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEEI-0000105213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000001316Medicaid
DE1000001316Medicaid
5673200001Medicare NSC
00B094F29Medicare ID - Type Unspecified
G00829Medicare ID - Type UnspecifiedPROVIDER ID NUMBER