Provider Demographics
NPI:1801896113
Name:HATCH, KENNETH L (DPM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:HATCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 FOREST DR
Mailing Address - Street 2:STE 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:
Practice Address - Street 1:1831 FOREST DR
Practice Address - Street 2:STE 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:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00409213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
323730-05OtherBCBS OF MD
8224-0001OtherBCBS NCA
T59827Medicare UPIN
323730-05OtherBCBS OF MD