Provider Demographics
NPI:1144277609
Name:HATCH, STEPHAN (MD)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:HATCH
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 1849
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1849
Mailing Address - Country:US
Mailing Address - Phone:207-777-1439
Mailing Address - Fax:207-777-1439
Practice Address - Street 1:365 MONTAUK AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-442-0711
Practice Address - Fax:860-443-4458
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24180207L00000X
VT042.0012965207L00000X
MA234074207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1144277609Medicaid