Provider Demographics
NPI:1780613844
Name:HATFIELD, GARY R (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:HATFIELD
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:PO BOX 1638
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1638
Mailing Address - Country:US
Mailing Address - Phone:207-777-4111
Mailing Address - Fax:207-783-6660
Practice Address - Street 1:3 WILLOW RUN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8501
Practice Address - Country:US
Practice Address - Phone:207-795-6800
Practice Address - Fax:207-795-6140
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME269270099Medicaid
ME269270099Medicaid
MEMM2479Medicare ID - Type Unspecified