Healthcare Provider Details

I. General information

NPI: 1043201049
Provider Name (Legal Business Name): JOHN MARK HATHEWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 OLENTANGY RIVER RD
COLUMBUS OH
43212-3120
US

IV. Provider business mailing address

70 S CLEVELAND AVE STE 100
WESTERVILLE OH
43081-1397
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-6555
  • Fax:
Mailing address:
  • Phone: 614-890-6555
  • Fax: 614-461-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35032559
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: