Provider Demographics
NPI:1801838248
Name:HATCH, JEREMY P (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:P
Last Name:HATCH
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 1:272 BAMBERG DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7400
Mailing Address - Country:US
Mailing Address - Phone:802-370-2879
Mailing Address - Fax:843-705-7034
Practice Address - Street 1:75 BAYLOR DR
Practice Address - Street 2:SUITE 155
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8965
Practice Address - Country:US
Practice Address - Phone:843-682-7480
Practice Address - Fax:843-705-7034
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0011130207X00000X
SC2036552207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014109Medicaid
VTP00618356OtherRAILROAD MEDICARE
SC365526Medicaid
SCSC30978297Medicare UPIN
VT0005269Medicare PIN
SC365526Medicaid
VTG46624Medicare UPIN