Provider Demographics
NPI:1891778916
Name:HATCHER, RONALD A (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:HATCHER
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 1:2296 OPITZ BLVD
Mailing Address - Street 2:#440
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3300
Mailing Address - Country:US
Mailing Address - Phone:703-878-0740
Mailing Address - Fax:703-878-3933
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:#440
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3300
Practice Address - Country:US
Practice Address - Phone:703-878-0740
Practice Address - Fax:703-878-3933
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040926174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006205577Medicaid
160001880Medicare ID - Type Unspecified
VA006205577Medicaid