Provider Demographics
NPI: | 1508825811 |
---|---|
Name: | HAWTHORN MEDICAL ASSOCIATES, LLC |
Entity Type: | Organization |
Organization Name: | HAWTHORN MEDICAL ASSOCIATES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GULAREK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 508-996-3991 |
Mailing Address - Street 1: | PO BOX 3076 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOSTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02241-3076 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 508-996-3991 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 535 FAUNCE CORNER RD |
Practice Address - Street 2: | |
Practice Address - City: | NORTH DARTMOUTH |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02747-1242 |
Practice Address - Country: | US |
Practice Address - Phone: | 508-996-3991 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-03-23 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
Not Answered | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
Not Answered | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
Not Answered | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
Not Answered | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
Not Answered | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
Not Answered | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
Not Answered | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
Not Answered | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
Not Answered | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
Not Answered | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
Not Answered | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
Not Answered | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
Not Answered | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | M17180 | Other | BLUE CROSS GROUP NUMBER |
MA | 667827 | Other | TUFTS HEALTH PLAN GROUP |
MA | 9786104 | Medicaid | |
MA | 667827 | Other | TUFTS HEALTH PLAN GROUP |