Active NPI
Taylor Joseph Hathaway, D.O.
- Pediatrics Physician
- Hollywood, FL
National Provider Identifier
1255744272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- OS14641
- Practice address
- 3200 W Quayside Dr
Hollywood, FL 33026-3789 - Phone
- (754) 247-1213
- NPI assigned
- Jun 6, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | OS14641 | FL | Primary |
Addresses
Primary practice location
3200 W Quayside Dr
Hollywood, FL 33026-3789
Mailing address
2114 N Flamingo Rd # 2100
Pembroke Pines, FL 33028-3501
Phone (754) 247-1213
Other practice location 1
5992 Coral Ridge Dr # B-11
Coral Springs, FL 33076-3302
Phone (754) 484-4767
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020815500 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS14641 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Form Health Associates Ma, P.C. | Past | Accepting new patients | |
| PM Pediatrics of Florida | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- thathaway@pa.trimed.direct-ci.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Endocrinology, Diabetes & Metabolism Physician
- Boston, MA
- NPI 1386260594
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737676800000",
"number": "1255744272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2114 N FLAMINGO RD # 2100",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330283501",
"telephone_number": "754-247-1213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 W QUAYSIDE DR",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330263789",
"telephone_number": "754-247-1213"
}
],
"practiceLocations": [
{
"address_1": "5992 Coral Ridge Dr # B-11",
"address_purpose": "LOCATION",
"city": "Coral Springs",
"state": "FL",
"postal_code": "330763302",
"country_code": "US",
"telephone_number": "754-484-4767",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HATHAWAY",
"first_name": "TAYLOR",
"middle_name": "JOSEPH",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-06",
"last_updated": "2025-01-24",
"certification_date": "2025-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "OS14641",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "020815500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hollywood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.