Provider Demographics
NPI:1811957863
Name:HAWKINS, KATHRYN X (RD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:X
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:XANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 21182
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-368-8640
Mailing Address - Fax:410-368-8644
Practice Address - Street 1:3421 BENSON AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-368-2700
Practice Address - Fax:410-368-3569
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02352133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK519M304Medicare PIN
Q52069Medicare UPIN