Ann Hathaway, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G42615 Issued in CA

Practice address

25 Mitchell Blvd
#3
San Rafael, CA 94903-2007

Phone

(415) 499-0966

Fax

(415) 446-0118

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2016 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093893752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 MAHOGANY DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949033132",
            "telephone_number": "415-472-6849",
            "fax_number": "415-446-0118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MITCHELL BLVD",
            "address_2": "#3",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032007",
            "telephone_number": "415-499-0966",
            "fax_number": "415-446-0118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHAWAY",
        "first_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G42615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G426151",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adrienne L Hart, MA, MFT
• Harvinder Mundh MD Corporation
• Thia Haselton
• Silva Hassert
• Katharine Douglas Hatch, PH.D.
• Lisa Hauck-Loy, LMFT
• Carley Lauren Hauck, MA
• Kayla Haupt, M.S.
• Maryam Havaei
• Bianca Lana Havel

• Family Medicine Physician in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.