Healthcare Provider Details

I. General information

NPI: 1740251545
Provider Name (Legal Business Name): RICHARD ALLEN HAWKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5003A VENABLE AVE
CHARLESTON WV
25304-2042
US

IV. Provider business mailing address

5003A VENABLE AVE
CHARLESTON WV
25304-2042
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-5400
  • Fax: 304-925-5309
Mailing address:
  • Phone: 304-925-5400
  • Fax: 304-925-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number09244
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: