Provider Demographics
NPI:1982615795
Name:HATHWAY, JEFFREY ERIC (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ERIC
Last Name:HATHWAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66B CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2179
Mailing Address - Country:US
Mailing Address - Phone:978-657-3826
Mailing Address - Fax:
Practice Address - Street 1:66B CONCORD ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2179
Practice Address - Country:US
Practice Address - Phone:978-657-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4770363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical