Healthcare Provider Details

I. General information

NPI: 1457351975
Provider Name (Legal Business Name): VIRGIL A HATCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 UNION SQ E STE 516
NEW YORK NY
10003-3244
US

IV. Provider business mailing address

228 E ROUTE 59 # 408
NANUET NY
10954-2905
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-0900
  • Fax: 718-362-1651
Mailing address:
  • Phone: 718-362-1411
  • Fax: 718-362-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number138498
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number138498
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number138498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: