Provider Demographics
NPI:1922720291
Name:HAWKES, MATTHEW SHANNON
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SHANNON
Last Name:HAWKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MARION ST # 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-3838
Mailing Address - Country:US
Mailing Address - Phone:917-642-5755
Mailing Address - Fax:
Practice Address - Street 1:204 MARION ST # 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-3838
Practice Address - Country:US
Practice Address - Phone:917-642-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist