Provider Demographics
NPI:1265422323
Name:HATCHER, KIM ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:ALAN
Last Name:HATCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1265 WAYNE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-349-7980
Mailing Address - Fax:724-349-7988
Practice Address - Street 1:119 PROFESSIONAL CTR
Practice Address - Street 2:1265 WAYNE AVENUE SUITE 107
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-349-7980
Practice Address - Fax:724-349-7988
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022389E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B36325Medicare UPIN
PA098866Medicare ID - Type Unspecified