Healthcare Provider Details

I. General information

NPI: 1811261803
Provider Name (Legal Business Name): JUSTIN DAVID HAMILTON RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST INPATIENT ONCOLOGY PA SERVICE, #325
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

5613 ROYAL TROON WAY
AVON IN
46123-8147
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-7576
  • Fax: 646-962-0115
Mailing address:
  • Phone: 812-239-6662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number015395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: