Provider Demographics
NPI:1477527711
Name:HITCHCOCK, MICHAEL GEORGE (MBCHB, MBA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:MBCHB, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100559
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0559
Mailing Address - Country:US
Mailing Address - Phone:843-664-4300
Mailing Address - Fax:843-664-4308
Practice Address - Street 1:1900 S HAWTHORNE RD
Practice Address - Street 2:SUITE 366
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3913
Practice Address - Country:US
Practice Address - Phone:336-760-1388
Practice Address - Fax:336-760-1398
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300150207ZP0101X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10733OtherPARTNERS
VA6601171Medicaid
NC8942619Medicaid
WV216029000Medicaid
SCQ00150Medicaid
NC5178126OtherAETNA
NC42619OtherBCBS
NC98672OtherMEDCOST
NC8942619Medicaid
NC10733OtherPARTNERS
VA6601171Medicaid
WV216029000Medicaid
NC2209616BMedicare PIN