Healthcare Provider Details

I. General information

NPI: 1033110390
Provider Name (Legal Business Name): WILLIAM JOHN HAMMERASH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708C LISBON CENTER DR
WOODBINE MD
21797-8600
US

IV. Provider business mailing address

5106 BONNIE BRANCH RD
ELLICOTT CITY MD
21043-7034
US

V. Phone/Fax

Practice location:
  • Phone: 410-489-7777
  • Fax: 410-795-8920
Mailing address:
  • Phone: 410-480-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0055926
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: