Provider Demographics
NPI:1154683290
Name:HATTAN, MARY KATE R (MD)
Entity Type:Individual
Prefix:
First Name:MARY KATE
Middle Name:R
Last Name:HATTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY KATE
Other - Middle Name:
Other - Last Name:ROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 FOUNDRY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5421
Mailing Address - Country:US
Mailing Address - Phone:603-228-0071
Mailing Address - Fax:603-228-7014
Practice Address - Street 1:18 FOUNDRY ST STE 201
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5421
Practice Address - Country:US
Practice Address - Phone:603-228-0071
Practice Address - Fax:603-228-7014
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252007207Q00000X
NH18176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine