MEDICARE: DR. CHARLOTTE 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	207Q00000X	Family Medicine Physician	153999	NY

General Provider Information

NPI Number	:	1790856029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLOTTE HAWKINS MD

Provider Business Mailing Address
First Line	:	4077 WEST RD
Second Line	:
City	:	CORTLAND
State	:	NY
Zip	:	13045-1637
Country	:	US
Telephone Number	:	607-753-9977
Fax Number	:	607-753-7311

Provider Business Practice Location Address
First Line	:	4077 WEST RD
Second Line	:
City	:	CORTLAND
State	:	NY
Zip	:	13045-1637
Country	:	US
Telephone Number	:	607-753-9977
Fax Number	:	607-753-7311

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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