Healthcare Provider Details

I. General information

NPI: 1376745471
Provider Name (Legal Business Name): JASON SOLOMON HAWKSWORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

9514 KENTSTONE DR
BETHESDA MD
20817-2564
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-0914
  • Fax:
Mailing address:
  • Phone: 240-381-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101239900
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number323394
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberMD040834
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: