Provider Demographics
NPI:1447293154
Name:HATSENGATE, DAVIN B (MD)
Entity type:Individual
Prefix:
First Name:DAVIN
Middle Name:B
Last Name:HATSENGATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVIN
Other - Middle Name:B
Other - Last Name:HATFIELD-WESTGATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6323 7TH AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4742
Mailing Address - Country:US
Mailing Address - Phone:718-921-7601
Mailing Address - Fax:
Practice Address - Street 1:6323 7TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4742
Practice Address - Country:US
Practice Address - Phone:718-921-7601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236438207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02720143Medicaid
NYI48731Medicare UPIN
NY0105WMMedicare ID - Type Unspecified