Basic Information
| Provider Information | |||||||||
| NPI: | 1477527711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HITCHCOCK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.B.CH.B., MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100559 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295010559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436644300 | ||||||||
| FaxNumber: | 8436644308 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 S HAWTHORNE RD | ||||||||
| Address2: | SUITE 366 | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271033913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367601388 | ||||||||
| FaxNumber: | 3367601398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 04/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 9300150 | NC | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZD0900X | 9300150 | NC | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
ID Information
| ID | Type | State | Issuer | Description | 10733 | 01 | NC | PARTNERS | OTHER | 6601171 | 05 | VA | MEDICAID | 8942619 | 05 | NC | MEDICAID | 216029000 | 05 | WV | MEDICAID | Q00150 | 05 | SC | MEDICAID | 5178126 | 01 | NC | AETNA | OTHER | 42619 | 01 | NC | BCBS | OTHER | 98672 | 01 | NC | MEDCOST | OTHER |