1235159252 NPI number — DR. MICHAEL L HAWTHORNE M.D.

Table of content: DR. MICHAEL L HAWTHORNE M.D. (NPI 1235159252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235159252 NPI number — DR. MICHAEL L HAWTHORNE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWTHORNE
Provider First Name:
MICHAEL
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235159252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3525 PRYTANIA ST
Provider Second Line Business Mailing Address:
STE 526
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70115-8127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-872-6210
Provider Business Mailing Address Fax Number:
985-876-7743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 BELANGER ST
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
HOUMA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70360-4463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-872-6210
Provider Business Practice Location Address Fax Number:
985-876-7743
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  33315 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00385330 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1571431 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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