Provider Demographics
NPI:1902999519
Name:HAMILTON, VIRGINA (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-3210
Mailing Address - Country:US
Mailing Address - Phone:781-257-5151
Mailing Address - Fax:
Practice Address - Street 1:4 TOWER RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-3210
Practice Address - Country:US
Practice Address - Phone:781-257-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015302208000000X, 2080P0207X
MA1571092080P0207X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME319920099Medicaid
MM8394Medicare ID - Type Unspecified
F85788Medicare UPIN