Provider Demographics
NPI:1831155068
Name:HATCH, SHARON J (PA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:HATCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2206
Mailing Address - Country:US
Mailing Address - Phone:617-418-0218
Mailing Address - Fax:
Practice Address - Street 1:284 CANTON ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2206
Practice Address - Country:US
Practice Address - Phone:617-418-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103050363AS0400X
MAPA4910363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292406400Medicaid
FLU7491ZMedicare PIN
FLS53513Medicare UPIN