Provider Demographics
NPI:1184910556
Name:HAWTIN, MELISSA LYNNE (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNNE
Last Name:HAWTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:824 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4478
Mailing Address - Country:US
Mailing Address - Phone:610-935-7300
Mailing Address - Fax:610-917-0646
Practice Address - Street 1:824 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4478
Practice Address - Country:US
Practice Address - Phone:610-935-7300
Practice Address - Fax:610-917-0646
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013944207Q00000X
PAOS016310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102929547 0001Medicaid
PA352169Medicare PIN