Basic Information
| Provider Information | |||||||||
| NPI: | 1215925631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAWKINS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301C US ROUTE 1 | ||||||||
| Address2: | |||||||||
| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040749701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073968600 | ||||||||
| FaxNumber: | 2073968632 | ||||||||
| Practice Location | |||||||||
| Address1: | 887 CONGRESS ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077746368 | ||||||||
| FaxNumber: | 2077749388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | NH-8161 | NH | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 011491 | ME | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | NH-8161 | NH | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | MD11491 | ME | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | MD11491 | ME | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 020010743 | 01 | ME | RR MEDICARE | OTHER | 298470099 | 05 | ME | MEDICAID | 30005163 | 05 | NH | MEDICAID |