Active NPI
Mark Allen Hathaway
- Private Vehicle
- Portland, OR
National Provider Identifier
1942517131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Private Vehicle
- License
- 3831943
- Practice address
- 833 SW 11TH Ave
Suite 428
Portland, OR 97205-2125 - Phone
- (503) 228-1510
- NPI assigned
- Sep 9, 2010
- 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 |
|---|---|---|---|---|
| Private Vehicle | 347C00000X | 3831943 | OR | Primary |
Addresses
Primary practice location
833 SW 11TH Ave
Suite 428
Portland, OR 97205-2125
Mailing address
833 SW 11TH Ave
Suite 428
Portland, OR 97205-2125
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3831943 | OR | MD | Private Vehicle |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283990400000",
"number": "1942517131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "833 SW 11TH AVE",
"address_2": "SUITE 428",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "833 SW 11TH AVE",
"address_2": "SUITE 428",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052125",
"telephone_number": "503-228-1510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HATHAWAY",
"first_name": "MARK",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-09",
"last_updated": "2010-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": "OR",
"license": "3831943",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.