Provider Demographics
NPI:1649499179
Name:KENNETH L HATCH DPM PA
Entity type:Organization
Organization Name:KENNETH L HATCH DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-263-7093
Mailing Address - Street 1:1831 FOREST DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4430
Mailing Address - Country:US
Mailing Address - Phone:410-263-7093
Mailing Address - Fax:410-263-7094
Practice Address - Street 1:1831 FOREST DR
Practice Address - Street 2:SUITE C
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4430
Practice Address - Country:US
Practice Address - Phone:410-263-7093
Practice Address - Fax:410-263-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD409213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT081Medicare ID - Type Unspecified
MDT59827Medicare UPIN