Provider Demographics
NPI:1386618874
Name:HATHAWAY, DANIEL E (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:HATHAWAY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:401 PHALEN BLVD
Mailing Address - Street 2:21110Q RHUEMATOLOGY DR HATHAWAY
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-5302
Mailing Address - Country:US
Mailing Address - Phone:651-254-7800
Mailing Address - Fax:651-254-7806
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:MAIL STOP 41103A
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7800
Practice Address - Fax:651-254-7806
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2015-08-11
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Provider Licenses
StateLicense IDTaxonomies
MN20389207RR0500X
WI17329207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN528877100Medicaid
MN528877100Medicaid
A94362Medicare UPIN