MEDICARE: NATHAN MORRIS HAMEROFF 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	2085R0202X	Diagnostic Radiology Physician	ME11683	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300075305	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	52796	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053367904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN MORRIS HAMEROFF M.D.

Provider Business Mailing Address
First Line	:	1190 80TH STREET CT S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-2725
Country	:	US
Telephone Number	:	727-384-0395
Fax Number	:	727-343-5552

Provider Business Practice Location Address
First Line	:	5880 49TH ST N
Second Line	:	SUITE 104
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2150
Country	:	US
Telephone Number	:	727-521-9552
Fax Number	:	727-528-4757

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	04/19/2012

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Directions to “ NATHAN MORRIS HAMEROFF M.D.” Practice Location

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