Provider Demographics
NPI:1588648547
Name:HAWKINS, MARY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 ANNAPOLIS RD STE 310
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1744
Mailing Address - Country:US
Mailing Address - Phone:410-874-1400
Mailing Address - Fax:410-367-2202
Practice Address - Street 1:1106 ANNAPOLIS RD STE 310
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1744
Practice Address - Country:US
Practice Address - Phone:410-874-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003960207Q00000X
MDD84546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000486301Medicaid
DE0000486301Medicaid
DE000K60M43Medicare ID - Type Unspecified