Healthcare Provider Details

I. General information

NPI: 1104891944
Provider Name (Legal Business Name): TERRESA LOUISE HAWTHORNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 W BROAD ST
COLUMBUS OH
43222-1352
US

IV. Provider business mailing address

1155 E MAIN ST
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 614-274-1455
  • Fax: 614-274-1433
Mailing address:
  • Phone: 740-277-6237
  • Fax: 740-689-6759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35047890
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number35047890
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35047890
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3504789OH
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: