Provider Demographics
NPI:1134160351
Name:HAWLEY, ROLLIN (MD)
Entity type:Individual
Prefix:
First Name:ROLLIN
Middle Name:
Last Name:HAWLEY
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24068-2147
Mailing Address - Country:US
Mailing Address - Phone:540-731-1677
Mailing Address - Fax:540-731-0387
Practice Address - Street 1:2900 LAMB CIRCLE
Practice Address - Street 2:SUITE 350
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073
Practice Address - Country:US
Practice Address - Phone:540-731-1677
Practice Address - Fax:540-731-0387
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134160351Medicaid
VA130000513Medicare PIN
VAD05957Medicare UPIN
VA1134160351Medicaid