MEDICARE: MARC ELLIOTT HAMILTON

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	175T00000X	Peer Specialist	PRS.007728	OH

General Provider Information

NPI Number	:	1093644825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC ELLIOTT HAMILTON

Provider Business Mailing Address
First Line	:	732 BECKMAN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-2165
Country	:	US
Telephone Number	:	937-253-1680
Fax Number	:

Provider Business Practice Location Address
First Line	:	732 BECKMAN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-2165
Country	:	US
Telephone Number	:	937-253-1680
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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