Provider Demographics
NPI:1881053528
Name:THOMAS F. HATTAR, M.D., P.A.
Entity type:Organization
Organization Name:THOMAS F. HATTAR, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-224-7615
Mailing Address - Street 1:617 RIDGELY AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1069
Mailing Address - Country:US
Mailing Address - Phone:410-224-7615
Mailing Address - Fax:410-224-7240
Practice Address - Street 1:617 RIDGELY AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1069
Practice Address - Country:US
Practice Address - Phone:410-224-7615
Practice Address - Fax:410-224-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050321261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF75I83Medicare UPIN