Provider Demographics
NPI:1104085745
Name:HAWTHORNE, KATIE M (MD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:M
Other - Last Name:BARELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:JD LANKENAU PAVILION, MEZZANINE
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-476-1000
Mailing Address - Fax:484-476-9000
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:JD LANKENAU PAVILION, MEZZANINE
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-1000
Practice Address - Fax:484-476-9000
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451805207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMAIN LINE HEALTHCARE TX ID