Provider Demographics
NPI:1790737013
Name:HATFIELD, MALLORY C (MD)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:C
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 NORTH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3845
Mailing Address - Country:US
Mailing Address - Phone:508-778-4888
Mailing Address - Fax:508-778-4887
Practice Address - Street 1:46 NORTH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3845
Practice Address - Country:US
Practice Address - Phone:508-778-4888
Practice Address - Fax:508-778-4887
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA82138207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2272937OtherAETNA
MA2500635OtherUNITED HEALTH CARE
MA792597OtherTUFTS HEALTH PLAN
MA0664672OtherCIGNA
MAJ19435OtherBLUE SHIELD
MA060050660OtherRR MEDICARE
MA300398OtherHARVARD PILGRIM HEALTH
MA3143945Medicaid
MAG21500Medicare UPIN
MA2272937OtherAETNA