Provider Demographics
NPI:1548641038
Name:HAMLEY, MATTHEW (CST/CSFA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HAMLEY
Suffix:
Gender:M
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 BIRCH TRACE DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4914
Mailing Address - Country:US
Mailing Address - Phone:330-501-2859
Mailing Address - Fax:
Practice Address - Street 1:2315 BIRCH TRACE DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4914
Practice Address - Country:US
Practice Address - Phone:330-501-2859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical