Healthcare Provider Details

I. General information

NPI: 1326088980
Provider Name (Legal Business Name): ROBERT S HAWKINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DEPOT SQ
ST JOHNSBURY VT
05819-2659
US

IV. Provider business mailing address

401 E MAIN ST
NEWPORT VT
05855-5890
US

V. Phone/Fax

Practice location:
  • Phone: 802-327-7079
  • Fax: 28-661-3948
Mailing address:
  • Phone: 802-327-7079
  • Fax: 802-866-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberT0539
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1954
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number032.0085469
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: