Healthcare Provider Details

I. General information

NPI: 1730527995
Provider Name (Legal Business Name): ANDREW HATCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 LEWIS AVE
MERIDEN CT
06451-2101
US

IV. Provider business mailing address

435 LEWIS AVE
MERIDEN CT
06451-2101
US

V. Phone/Fax

Practice location:
  • Phone: 860-466-9349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8531
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA3923
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: