Healthcare Provider Details

I. General information

NPI: 1013161611
Provider Name (Legal Business Name): LORIE D HAMIWKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 18TH ST
COLUMBUS OH
43205-2654
US

IV. Provider business mailing address

555 S 18TH ST
COLUMBUS OH
43205-2654
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4634
  • Fax: 614-722-4633
Mailing address:
  • Phone: 614-722-4634
  • Fax: 614-722-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35092620
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35092620
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: