Provider Demographics
NPI:1851406383
Name:HAWKINS, DIANE E (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:E
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 1:510 CUMBERLAND STREET
Mailing Address - Street 2:EXECUTIVE PLAZA 4TH FLOOR
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201
Mailing Address - Country:US
Mailing Address - Phone:276-645-4758
Mailing Address - Fax:276-669-9093
Practice Address - Street 1:510 CUMBERLAND STREET
Practice Address - Street 2:EXECUTIVE PLAZA 4TH FLOOR
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201
Practice Address - Country:US
Practice Address - Phone:276-645-4758
Practice Address - Fax:276-669-9093
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010527432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54097963217OtherJOHN DEERE
VA180264OtherANTHEM BCBS
VA003749H69Medicare ID - Type Unspecified
VA180264OtherANTHEM BCBS