Provider Demographics
NPI:1326253865
Name:DR. CHARLOTTE HAWKINS
Entity Type:Organization
Organization Name:DR. CHARLOTTE HAWKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-753-9977
Mailing Address - Street 1:4077 WEST RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1637
Mailing Address - Country:US
Mailing Address - Phone:607-753-9977
Mailing Address - Fax:607-753-7311
Practice Address - Street 1:4077 WEST RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1637
Practice Address - Country:US
Practice Address - Phone:607-753-9977
Practice Address - Fax:607-753-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52778AMedicare ID - Type Unspecified