Healthcare Provider Details

I. General information

NPI: 1376644401
Provider Name (Legal Business Name): DENZIL W HAWKINBERRY II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 N KANAWHA ST
BUCKHANNON WV
26201-2714
US

IV. Provider business mailing address

34 N KANAWHA ST
BUCKHANNON WV
26201-2714
US

V. Phone/Fax

Practice location:
  • Phone: 304-473-2250
  • Fax: 304-924-5460
Mailing address:
  • Phone: 304-473-2250
  • Fax: 304-924-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20823
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number20823
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: