Provider Demographics
NPI:1093127383
Name:HATHAWAY, DAVID BREWSTER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BREWSTER
Last Name:HATHAWAY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 TRIPPS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-2937
Mailing Address - Country:US
Mailing Address - Phone:401-749-0030
Mailing Address - Fax:
Practice Address - Street 1:720 HARRISON AVE
Practice Address - Street 2:DOB-915
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2739792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry