Provider Demographics
NPI:1285981621
Name:HADLEY, DOUGLAS R (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:HADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 PRAIRIE ROSE PL
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6399
Mailing Address - Country:US
Mailing Address - Phone:410-653-8805
Mailing Address - Fax:
Practice Address - Street 1:8414 PRAIRIE ROSE PL
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6399
Practice Address - Country:US
Practice Address - Phone:410-653-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00056620207Q00000X
VA0202045772207Q00000X
UT156636-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine