Provider Demographics
NPI:1467793273
Name:HATHAWAY, ANDREW P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 W FAYETTE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2866
Mailing Address - Country:US
Mailing Address - Phone:315-937-3433
Mailing Address - Fax:315-449-0558
Practice Address - Street 1:5000 BRITTONFIELD PKWY STE A100
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9227
Practice Address - Country:US
Practice Address - Phone:315-449-3800
Practice Address - Fax:315-449-0558
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264018207Q00000X
NY264018-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03566525Medicaid
NY03566525Medicaid