Provider Demographics
NPI:1396792156
Name:HAUTHAWAY, MALCOLM (PAC)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:
Last Name:HAUTHAWAY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-778-7975
Mailing Address - Fax:603-778-7964
Practice Address - Street 1:330 BORTHWICK AVE STE 308
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7112
Practice Address - Country:US
Practice Address - Phone:603-431-5242
Practice Address - Fax:603-433-4045
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-06-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076274Medicaid
NH3076274Medicaid
NHAP2396Medicare PIN