Provider Demographics
NPI:1235108689
Name:HATHAWAY, LINDA J (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 EASTERN BYP
Mailing Address - Street 2:SUITE G2
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2422
Mailing Address - Country:US
Mailing Address - Phone:859-626-0074
Mailing Address - Fax:859-626-3265
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:OUPB1430
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-5641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK235802085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64306756Medicaid
OK200017270BMedicaid
F69687Medicare UPIN
KY64306756Medicaid
OK200017270BMedicaid
KYP400017934Medicare PIN