MEDICARE: FREDERICK CAMPBELL HAWKINS JR. D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS-002248-L	PA

General Provider Information

NPI Number	:	1023175130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK CAMPBELL HAWKINS JR. D.O.

Provider Business Mailing Address
First Line	:	3035 W DIAMOND ST.
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121
Country	:	US
Telephone Number	:	215-235-9090
Fax Number	:	215-235-7426

Provider Business Practice Location Address
First Line	:	3035 W. DIAMOND ST.
Second Line	:
City	:	PHILA.
State	:	PA
Zip	:	19121
Country	:	US
Telephone Number	:	215-235-9090
Fax Number	:	215-235-7426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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