Individual
JESSICA L HATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 491-6000
(317) 491-6534
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01090724A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
46784
KY
207ZP0213X
Pediatric Pathology Physician
01090724A
IN
207ZP0213X
Pediatric Pathology Physician
46784
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000945301
ANTHEM
KY
05
—
201311310
—
IN
05
—
201311310A
—
IN
01
—
50092843
PASSPORT
KY
05
—
7100369820
—
KY
Enumeration date
04/19/2010
Last updated
05/22/2025
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