Active NPI
Mark Hathaway, MD
- Obstetrics & Gynecology Physician
- Washington, DC
National Provider Identifier
1720068133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- MD21559
- Practice address
- 1225 4TH St NE
Washington, DC 20002-3431 - Phone
- (202) 347-8512
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | D0052934 | MD | |
| Obstetrics & Gynecology Physician | 207V00000X | MD21559 | DC | Primary |
Addresses
Primary practice location
1225 4TH St NE
Washington, DC 20002-3431
Mailing address
1225 4TH St NE
Washington, DC 20002-3431
Phone (202) 347-8512
Other practice location 1
19650 Club House Rd # 101
Montgomery Village, MD 20886-3003
Phone (301) 208-1300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 025687900 | Medicaid | DC | |
| 759210800 | Medicaid | DC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD21559 | DC | MD | Obstetrics & Gynecology Physician |
| D0052934 | MD | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Planned Parenthood of Metropolitan Washington DC | Past | Accepting new patients |
Interoperability endpoints
- mark.hathaway.1@10306.direct.athenahealth.com
Organizations & group practices 3
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.
-
- Federally Qualified Health Center (FQHC)
- Washington, DC
- NPI 1093894172
-
- Gynecology Physician
- Washington, DC
- NPI 1538253786
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742515200000",
"number": "1720068133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1225 4TH ST NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200023431",
"telephone_number": "202-347-8512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 4TH ST NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200023431",
"telephone_number": "202-347-8512"
}
],
"practiceLocations": [
{
"address_1": "19650 Club House Rd # 101",
"address_purpose": "LOCATION",
"city": "Montgomery Village",
"state": "MD",
"postal_code": "208863003",
"country_code": "US",
"telephone_number": "301-208-1300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HATHAWAY",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-20",
"last_updated": "2025-03-21",
"certification_date": "2025-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MD",
"license": "D0052934",
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "DC",
"license": "MD21559",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "025687900",
"state": "DC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "759210800",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.