Provider Demographics
NPI:1528055308
Name:WANAMAKER, HAYES (MD)
Entity type:Individual
Prefix:DR
First Name:HAYES
Middle Name:
Last Name:WANAMAKER
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 1:721 E GENESEE ST
Mailing Address - Street 2:FL 2ND
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1505
Mailing Address - Country:US
Mailing Address - Phone:315-476-3127
Mailing Address - Fax:315-476-3136
Practice Address - Street 1:721 E GENESEE ST
Practice Address - Street 2:FL 2ND
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1505
Practice Address - Country:US
Practice Address - Phone:315-476-3127
Practice Address - Fax:315-476-3136
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1722581207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01258828Medicaid
NY01258828Medicaid
E59293Medicare UPIN