Healthcare Provider Details

I. General information

NPI: 1831155068
Provider Name (Legal Business Name): SHARON J HATCH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 CANTON ST
WESTWOOD MA
02090-2206
US

IV. Provider business mailing address

284 CANTON ST
WESTWOOD MA
02090-2206
US

V. Phone/Fax

Practice location:
  • Phone: 617-418-0218
  • Fax:
Mailing address:
  • Phone: 617-418-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4910
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9103050
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: