Provider Demographics
NPI:1871889303
Name:HAYDEN, TASSY N (MD)
Entity type:Individual
Prefix:
First Name:TASSY
Middle Name:N
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2935
Mailing Address - Country:US
Mailing Address - Phone:314-647-2200
Mailing Address - Fax:314-647-4172
Practice Address - Street 1:2340 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2935
Practice Address - Country:US
Practice Address - Phone:314-647-2200
Practice Address - Fax:314-647-4172
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA248385207Q00000X
MO2014021718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1871889303Medicaid
MO2014021718OtherMO STATE LICENSE