Provider Demographics
NPI:1518028018
Name:HATHAWAY, DARREN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:PAUL
Last Name:HATHAWAY
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 1:830 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1446
Practice Address - Country:US
Practice Address - Phone:269-781-9822
Practice Address - Fax:269-781-9839
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDH073800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4421664Medicaid
MI4421664Medicaid
MI0N52860Medicare PIN
MIG83248Medicare UPIN
MI0N52860Medicare PIN