=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548751464
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA CATHERINE HAWKINS DM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2018
-----------------------------------------------------
Last Update Date | 07/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 N GREENE ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21201-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | SUITE A 409 CENTER STREET
-----------------------------------------------------
City | JOHNSONBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15845-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-965-2433
-----------------------------------------------------
Fax | 814-965-2421
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS042099
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS042099
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------