Provider Demographics
NPI:1770593576
Name:HATOK, AMY B (PA)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:B
Last Name:HATOK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8777
Mailing Address - Fax:757-232-8866
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4430
Practice Address - Country:US
Practice Address - Phone:757-877-4221
Practice Address - Fax:757-886-1042
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-09-27
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Provider Licenses
StateLicense IDTaxonomies
VA0110001010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA247762OtherANTHEM CROSSOVER PN
VA010269695Medicaid
VA247762OtherANTHEM CROSSOVER PN
VA010861T73Medicare PIN