Healthcare Provider Details

I. General information

NPI: 1275537862
Provider Name (Legal Business Name): PAUL D HAMM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 GREENVILLE AVE
CLARION PA
16214-1645
US

IV. Provider business mailing address

180 GREENVILLE AVE
CLARION PA
16214-1645
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-7651
  • Fax: 814-226-4051
Mailing address:
  • Phone: 814-226-7651
  • Fax: 814-226-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS010606L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0018406950001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: