Provider Demographics
NPI:1699709212
Name:HATCH, WENDELL D (MD)
Entity type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:D
Last Name:HATCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 HUDSON DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4451
Mailing Address - Country:US
Mailing Address - Phone:330-655-3800
Mailing Address - Fax:330-655-3828
Practice Address - Street 1:5655 HUDSON DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4451
Practice Address - Country:US
Practice Address - Phone:330-655-1869
Practice Address - Fax:330-655-3828
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV97742085R0202X
OH25.0001282085R0202X
WAMD600748742085R0202X
HIMD-143392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV201890001Medicaid
OH2935891Medicaid
NV34741Medicare ID - Type Unspecified
OH2935891Medicaid
NVF19735Medicare UPIN