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General NPI Number Information
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NPI Number | 1093893752
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Entity Type | Individual
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Provider Name | ANN HATHAWAY MD
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25 MITCHELL BLVD #3
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2007
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Country | US
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Telephone | 415-499-0966
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Fax | 415-446-0118
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Provider Business Mailing Address
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Address Line | 48 MAHOGANY DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3132
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Country | US
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Telephone | 415-472-6849
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Fax | 415-446-0118
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G42615
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License Number State | CA
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