Healthcare Provider Details

I. General information

NPI: 1386764504
Provider Name (Legal Business Name): CLARISA C. HAMMER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 220
ALEXANDRIA VA
22304-1306
US

IV. Provider business mailing address

4660 KENMORE AVE STE 220
ALEXANDRIA VA
22304-1306
US

V. Phone/Fax

Practice location:
  • Phone: 703-832-4000
  • Fax: 703-832-4001
Mailing address:
  • Phone: 703-832-4000
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34009035
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A10466
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberH75038
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number0102203916
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: