MEDICARE: HAMLET HMA PPM, LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1518269828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMLET HMA PPM, LLC

Provider Business Mailing Address
First Line	:	5811 PELICAN BAY BLVD
Second Line	:	SUITE 5001
City	:	NAPLES
State	:	FL
Zip	:	34108-2733
Country	:	US
Telephone Number	:	239-598-3131
Fax Number	:	239-592-0438

Provider Business Practice Location Address
First Line	:	125 BILTMORE DR
Second Line	:	SUITE 1
City	:	ROCKINGHAM
State	:	NC
Zip	:	28379-4994
Country	:	US
Telephone Number	:	910-895-8890
Fax Number	:	910-895-8895

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MICHAEL L GINGRAS
Credential	:
Telephone Number	:	239-598-3131

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	11/28/2012

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