1376644401 NPI number — DENZIL W HAWKINBERRY II MD

Table of content: DENZIL W HAWKINBERRY II MD (NPI 1376644401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376644401 NPI number — DENZIL W HAWKINBERRY II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWKINBERRY
Provider First Name:
DENZIL
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
MD
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:
1376644401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 N KANAWHA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUCKHANNON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26201-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-473-2250
Provider Business Mailing Address Fax Number:
304-924-5460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 N KANAWHA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKHANNON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26201-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-473-2250
Provider Business Practice Location Address Fax Number:
304-924-5460
Provider Enumeration Date:
09/25/2006

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: 207L00000X , with the licence number:  20823 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LA0401X , with the licence number: 20823 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20554238700 . This is a "WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810006746 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF0767 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2528367 . This is a "OHIO MEDICAID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 270052997004 . This is a "TRICARE MAAC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00407274 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001706469 . This is a "BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810001133 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001808009 . This is a "MSBCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001907643 . This is a "MSBCBS GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2332177174-00 . This is a "OHIO WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 27005997004 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1068812 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 205542387 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 205542387001 . This is a "TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00382001 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0207026000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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