Provider Demographics
NPI:1154709830
Name:HAWK, JUSTIN P (PA-C)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:P
Last Name:HAWK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 AUBURN AVE STE C920A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-585-2663
Mailing Address - Fax:513-585-5157
Practice Address - Street 1:2139 AUBURN AVE STE C920A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-2663
Practice Address - Fax:513-585-5157
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008894363A00000X
IN10001827A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264430295Medicare PIN
INP01718877Medicare PIN