Provider Demographics
NPI:1972212785
Name:HAWK, ERIC NATHANIEL (BOC ORTHOTIST)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:NATHANIEL
Last Name:HAWK
Suffix:
Gender:M
Credentials:BOC ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4954 N PALMER RD RM 1501
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5620
Mailing Address - Country:US
Mailing Address - Phone:301-295-4866
Mailing Address - Fax:
Practice Address - Street 1:4954 N PALMER RD RM 1501
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5620
Practice Address - Country:US
Practice Address - Phone:301-295-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C51653OtherBOARD OF CERTIFICATION IN ORTHOTICS AND PROSTHETICS