MEDICARE: LARRY TODD HAWKINS MD

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	2084P0800X	Psychiatry Physician	35071411	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700881034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY TODD HAWKINS MD

Provider Business Mailing Address
First Line	:	PO BOX 449
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-0449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 N 7TH ST
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-2244
Country	:	US
Telephone Number	:	740-374-6338
Fax Number	:	740-374-6066

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	01/20/2021

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