Provider Demographics
NPI:1871545210
Name:HAWKINS, TRACY BANSIDHAR (DO)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:BANSIDHAR
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:JEAN
Other - Last Name:BANSIDHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:28 BARNET AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5102
Mailing Address - Country:US
Mailing Address - Phone:207-873-5044
Mailing Address - Fax:207-873-4344
Practice Address - Street 1:25 FIRST PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-5361
Practice Address - Country:US
Practice Address - Phone:207-873-4325
Practice Address - Fax:207-873-4344
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1665207R00000X
CA20A 7525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H26234Medicare UPIN
MM8500Medicare ID - Type UnspecifiedRAILROAD-INDIVIDUAL ID#
MM8500Medicare ID - Type UnspecifiedINDIVIDUAL ID#