Basic Information
| Provider Information | |||||||||
| NPI: | 1427217439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HATARA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | CRISTINA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 N FLAGLER DR | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334076109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616596543 | ||||||||
| FaxNumber: | 5616593533 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 N FLAGLER DR | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334076109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616596543 | ||||||||
| FaxNumber: | 5616593533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2008 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD158949 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | MD158949 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | ME145385 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 500650922 | 05 | OR | MEDICAID | P01178242 | 01 | OR | MEDICARE RAILROAD | OTHER |