Basic Information
Provider Information
NPI: 1689661910
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAY
FirstName: ROBERT
MiddleName: M.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 751649
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282751649
CountryCode: US
TelephoneNumber: 8437891620
FaxNumber: 8437242440
Practice Location
Address1: 180 WINGO WAY
Address2: SUITE 301
City: MOUNT PLEASANT
State: SC
PostalCode: 294641810
CountryCode: US
TelephoneNumber: 8438840302
FaxNumber: 8438499308
Other Information
ProviderEnumerationDate: 10/03/2005
LastUpdateDate: 08/12/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X15353SCY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
P0083485401SCRAILROAD MEDICARE ID-RSFPNOTHER
DM068305SC MEDICAID
15353105SC MEDICAID


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