MEDICARE: STEPHEN PATRICK HAMM PA-C

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	363A00000X	Physician Assistant	1159	SC
2	363AM0700X	Medical Physician Assistant	1159	SC

General Provider Information

NPI Number	:	1639156094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN PATRICK HAMM PA-C

Provider Business Mailing Address
First Line	:	2845 TRICOM ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9172
Country	:	US
Telephone Number	:	843-863-8100
Fax Number	:	843-553-2122

Provider Business Practice Location Address
First Line	:	2845 TRICOM ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9172
Country	:	US
Telephone Number	:	843-863-8100
Fax Number	:	843-553-2122

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	02/10/2022

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