Provider Demographics
NPI:1689690950
Name:HUTCHINSON, LARRY D (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:HUTCHINSON
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 1:120 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-258-5141
Mailing Address - Fax:859-258-5168
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-258-5141
Practice Address - Fax:859-258-5168
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20191208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID LAB GRP
GA370009198OtherRR MEDICARE PIN
KY64201916Medicaid
KY4000501OtherMEDICARE LAB GRP
GACB5773OtherRR MEDICARE GRP
KY0787003Medicare ID - Type Unspecified