Provider Demographics
NPI:1760448419
Name:HATCH, ELLEN (LAC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10594 TWIN RIVERS RD
Mailing Address - Street 2:F-2
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2157
Mailing Address - Country:US
Mailing Address - Phone:410-980-5847
Mailing Address - Fax:
Practice Address - Street 1:10594 TWIN RIVERS RD
Practice Address - Street 2:F-2
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2157
Practice Address - Country:US
Practice Address - Phone:410-980-5847
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01501171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist