Provider Demographics
NPI:1992896757
Name:HAWTHORNE, NORMAN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:JAMES
Last Name:HAWTHORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3599 SUELDO ST
Mailing Address - Street 2:110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7329
Mailing Address - Country:US
Mailing Address - Phone:805-786-2500
Mailing Address - Fax:805-781-0423
Practice Address - Street 1:77 CASA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5803
Practice Address - Country:US
Practice Address - Phone:805-786-2500
Practice Address - Fax:805-781-0423
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG19194208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G191940Medicaid
CAWG19194AMedicare PIN
CAWG19194BMedicare PIN
CAWG19194DMedicare PIN
CAA40560Medicare UPIN
CAWG19194CMedicare PIN