Provider Demographics
NPI:1164166708
Name:HATHAWAY, SAMANTHA GRACE (DO)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:GRACE
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:GRACE
Other - Last Name:MICHALEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 SPRINGER RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-3404
Mailing Address - Country:US
Mailing Address - Phone:845-820-1864
Mailing Address - Fax:
Practice Address - Street 1:515 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1311
Practice Address - Country:US
Practice Address - Phone:607-798-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine