Provider Demographics
NPI:1003010893
Name:HATCHETTE, ANDREA S (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:HATCHETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:S
Other - Last Name:MARVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4333 N JOSEY LN STE 104
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4620
Mailing Address - Country:US
Mailing Address - Phone:972-394-4500
Mailing Address - Fax:972-394-8180
Practice Address - Street 1:4333 N JOSEY LN STE 104
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4620
Practice Address - Country:US
Practice Address - Phone:972-394-4500
Practice Address - Fax:972-394-8180
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN6479208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216780101Medicaid
TX216780102Medicaid
TX216780103Medicaid
BP1-0027249OtherINSTITUTIONAL PERMIT
TX216780102Medicaid
TXTXB112067Medicare PIN
TXTXB112069Medicare PIN