Healthcare Provider Details

I. General information

NPI: 1639667504
Provider Name (Legal Business Name): LORI G.M HUTCHINSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAINT ANDREWS LN
GLEN COVE NY
11542-2254
US

IV. Provider business mailing address

101 SAINT ANDREWS LN
GLEN COVE NY
11542-2254
US

V. Phone/Fax

Practice location:
  • Phone: 516-674-7631
  • Fax: 516-674-7639
Mailing address:
  • Phone: 516-674-7631
  • Fax: 516-674-7639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number309405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: