Provider Demographics
NPI:1114936234
Name:HAWKINS, RANDALL FLEMING (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:FLEMING
Last Name:HAWKINS
Suffix:
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 1:2520 VALLEY DRIVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-2031
Mailing Address - Country:US
Mailing Address - Phone:304-675-7700
Mailing Address - Fax:304-675-6510
Practice Address - Street 1:2520 VALLEY DRIVE
Practice Address - Street 2:SUITE 212
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2031
Practice Address - Country:US
Practice Address - Phone:304-675-7700
Practice Address - Fax:304-675-6510
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16211207R00000X
OH69109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0072981000Medicaid
OH0796714Medicaid
OH0796714Medicaid
E36055Medicare UPIN