Healthcare Provider Details

I. General information

NPI: 1912938440
Provider Name (Legal Business Name): RONALD G HUTCHINSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2044 ROUTE 32 SUITE 4
MODENA NY
12548
US

IV. Provider business mailing address

2044 ROUTE 32 SUITE 4
MODENA NY
12548
US

V. Phone/Fax

Practice location:
  • Phone: 845-883-5176
  • Fax: 845-883-5177
Mailing address:
  • Phone: 845-883-5176
  • Fax: 845-883-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number000189-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: