Provider Demographics
NPI:1356490429
Name:HITCHENS, JOHN THOMAS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:HITCHENS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 FARMSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1507
Mailing Address - Country:US
Mailing Address - Phone:410-692-6601
Mailing Address - Fax:410-692-9566
Practice Address - Street 1:1715 FARMSHIRE CT
Practice Address - Street 2:
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1507
Practice Address - Country:US
Practice Address - Phone:410-692-6601
Practice Address - Fax:410-692-9566
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR072213367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD43002552OtherRAIL ROAD MEDICARE
MD537091400Medicaid
MD537091400Medicaid