Provider Demographics
NPI:1376644401
Name:HAWKINBERRY, DENZIL W II (MD)
Entity Type:Individual
Prefix:
First Name:DENZIL
Middle Name:W
Last Name:HAWKINBERRY
Suffix:II
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 1:34 N KANAWHA ST
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2714
Mailing Address - Country:US
Mailing Address - Phone:304-473-2250
Mailing Address - Fax:304-924-5460
Practice Address - Street 1:34 N KANAWHA ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2714
Practice Address - Country:US
Practice Address - Phone:304-473-2250
Practice Address - Fax:304-924-5460
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20823207L00000X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV20554238700OtherWORKERS COMP
WV3810006746Medicaid
WVDF0767OtherRR MEDICARE
WV2528367OtherOHIO MEDICAID
WV270052997004OtherTRICARE MAAC
WVP00407274OtherRR MEDICARE
WV001706469OtherBLUE CROSS
WV3810001133Medicaid
WV001808009OtherMSBCBS
WV001907643OtherMSBCBS GROUP
WV2332177174-00OtherOHIO WORKERS COMP
WV27005997004OtherTRICARE
WV1068812OtherBRICKSTREET
WV205542387OtherTRICARE
WV205542387001OtherTRICARE
WVP00382001OtherRR MEDICARE
WV0207026000Medicaid
WV27005997004OtherTRICARE
WV9364011Medicare PIN
WV20554238700OtherWORKERS COMP
WV0207026000Medicaid
WV4204412Medicare PIN