MEDICARE: DR. ALECIA ANNE HATHAWAY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	0049873	CO
2	2083P0901X	Public Health & General Preventive Medicine Physician	G7416	TX

General Provider Information

NPI Number	:	1558732354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALECIA ANNE HATHAWAY M.D.

Provider Business Mailing Address
First Line	:	10997 E DISTANT HILLS DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85262-5210
Country	:	US
Telephone Number	:	480-939-0125
Fax Number	:

Provider Business Practice Location Address
First Line	:	4449 DENVER DRIVE
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093
Country	:	US
Telephone Number	:	480-939-0125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2015
Last Update Date	:	03/16/2023

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