Basic Information
| Provider Information | |||||||||
| NPI: | 1154683290 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HATTAN | ||||||||
| FirstName: | MARY KATE | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROD | ||||||||
| OtherFirstName: | MARY KATE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 18 FOUNDRY ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033015421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032280071 | ||||||||
| FaxNumber: | 6032287014 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 FOUNDRY ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033015421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032280071 | ||||||||
| FaxNumber: | 6032287014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 252007 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 18176 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.