Individual
MR. THOMAS GLEN HETTICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
21044 FREDERICK RD, GERMANTOWN, MD 20876-4132
(240) 238-5432
Mailing address
3534 DIAZ ST, TRINITY, FL 34655-2163
(727) 644-2597
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0009860
MD
363A00000X
Physician Assistant
PA9108323
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1049243
NCCPA CERTIFICATION NUM
—
Enumeration date
03/24/2006
Last updated
05/29/2025
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