Individual
DR. BRIAN W HAWTHORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
50 MERRICK ST, INDIANA, PA 15701-8988
(304) 276-1578
Mailing address
50 MERRICK ST, INDIANA, PA 15701-8988
(304) 276-1578
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
19027
WV
207Q00000X
Family Medicine Physician
Primary
MD061667L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001709238
GROUP BLUE SHIELD #
WV
01
—
001718039
IND BLUE SHIELD #
WV
05
—
1802281000
—
WV
05
—
3810002243
—
WV
Enumeration date
11/08/2005
Last updated
02/10/2020
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