Healthcare Provider Details

I. General information

NPI: 1184610966
Provider Name (Legal Business Name): RANDY HUTCHINGSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E ANTIETAM ST
HAGERSTOWN MD
21740-5724
US

IV. Provider business mailing address

119 KING ST
HAGERSTOWN MD
21740-5732
US

V. Phone/Fax

Practice location:
  • Phone: 301-665-1717
  • Fax: 301-665-1810
Mailing address:
  • Phone: 301-665-1717
  • Fax: 301-665-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR094924
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: