Provider Demographics
NPI:1912938440
Name:HUTCHINSON, RONALD G (PA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 ROUTE 32
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MODENA
Mailing Address - State:NY
Mailing Address - Zip Code:12548
Mailing Address - Country:US
Mailing Address - Phone:845-883-5176
Mailing Address - Fax:845-883-5177
Practice Address - Street 1:2044 ROUTE 32
Practice Address - Street 2:SUITE 4
Practice Address - City:MODENA
Practice Address - State:NY
Practice Address - Zip Code:12548
Practice Address - Country:US
Practice Address - Phone:845-883-5176
Practice Address - Fax:845-883-5177
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000189-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY986449OtherMVP
NYZ8747X0251Medicare ID - Type Unspecified
NY986449OtherMVP