MEDICARE: DR. FRED GEORGE HAMATY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	MD058303L	PA
2	207NS0135X	Procedural Dermatology Physician	MD058303L	PA
3	207N00000X	Dermatology Physician	MD058303L	PA

General Provider Information

NPI Number	:	1023058567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED GEORGE HAMATY M.D.

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9016
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	4731 ROUTE 30 STE 402
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-7260
Country	:	US
Telephone Number	:	724-552-0446
Fax Number	:	724-552-0445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/18/2021

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