Provider Demographics
NPI:1740251545
Name:HAWKINS, RICHARD ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5003A VENABLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2042
Mailing Address - Country:US
Mailing Address - Phone:304-925-5400
Mailing Address - Fax:304-925-5309
Practice Address - Street 1:5003A VENABLE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2042
Practice Address - Country:US
Practice Address - Phone:304-925-5400
Practice Address - Fax:304-925-5309
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09244207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0070158000Medicaid
WV0070158000Medicaid
WVHA0380921Medicare ID - Type Unspecified