Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Samantha Grace Hathaway, DO

Individual provider Family Medicine Physician · NPI 1164166708

Dr. Samantha Grace Hathaway, DO is a Family Practice in Johnson City, New York. Qualified in 2022, 4 years ago. Practices with Our Lady of Lourdes Memorial Hospital Inc, a 249-clinician group, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
4
Licensed in
NY
In the registry since
2022
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

515 Reynolds Rd
Johnson City, NY 13790-1311
Phone: (607) 798-5510
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 338813 (NY)

Record details

NPI number1164166708
Entity typeIndividual (Type 1)
GenderFemale
Credentials DO
Sole proprietorNo
NPI enumeratedApril 20, 2022
Last updated in NPPESJuly 24, 2025
Certification dateJuly 24, 2025
Mailing address104 Springer Rd, Binghamton, NY 13904-3404

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Our Lady Of Lourdes Memorial Hospital Inc — 249 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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