Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 297163-1 | NY |
NPI | 1003348582 |
---|---|
Provider Name | Bethany A Hawke |
First Address | Syracuse, NY 13210-2306 |
Second Address | Syracuse, NY 13210-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 11/08/2020 |