1447421763 NPI number — DEBORA RUSSWURM HATCH AUD

Table of content: DEBORA RUSSWURM HATCH AUD (NPI 1447421763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447421763 NPI number — DEBORA RUSSWURM HATCH AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATCH
Provider First Name:
DEBORA
Provider Middle Name:
RUSSWURM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447421763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 936
Provider Second Line Business Mailing Address:
EVMS MEDICAL GROUP
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23501-0936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-388-6200
Provider Business Mailing Address Fax Number:
757-388-6201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 GRESHAM DR
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23507-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-388-6200
Provider Business Practice Location Address Fax Number:
757-388-6201
Provider Enumeration Date:
03/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  2201001547 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)