Provider Demographics
NPI:1265652010
Name:HUTCHISON, KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:HUTCHISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 MOOSEHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:WALDO
Mailing Address - State:ME
Mailing Address - Zip Code:04915-3302
Mailing Address - Country:US
Mailing Address - Phone:207-722-3210
Mailing Address - Fax:
Practice Address - Street 1:237 MOOSEHEAD TRL
Practice Address - Street 2:
Practice Address - City:WALDO
Practice Address - State:ME
Practice Address - Zip Code:04915-3302
Practice Address - Country:US
Practice Address - Phone:207-722-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0085892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM2250Medicare ID - Type Unspecified