Provider Demographics
NPI:1801919881
Name:HAWTHORNE, ANDY LESTON (MD)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:LESTON
Last Name:HAWTHORNE
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 1:7200 WYOMING SPGS
Mailing Address - Street 2:STE 500
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4303
Mailing Address - Country:US
Mailing Address - Phone:512-244-0111
Mailing Address - Fax:512-244-2479
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:STE 500
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-244-0111
Practice Address - Fax:512-244-2479
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2640208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192955601Medicaid
TX9608066OtherAETNA
TX8AK836OtherBCBS
TX8K4899Medicare PIN
TX1801919881Medicare PIN