Provider Demographics
NPI:1730151184
Name:HAWTHORNE, HARRY R (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:R
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:PO BOX 12484
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2484
Mailing Address - Country:US
Mailing Address - Phone:318-448-1041
Mailing Address - Fax:318-448-0895
Practice Address - Street 1:2108 TEXAS AVE
Practice Address - Street 2:SUITE 2061
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3944
Practice Address - Country:US
Practice Address - Phone:318-448-1041
Practice Address - Fax:318-448-0895
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019431207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1991422Medicaid
LA060024552OtherRAILROAD MEDICARE
LAP00416292OtherRAILROAD MEDICARE
LAD80412Medicare UPIN
LA1991422Medicaid