Provider Demographics
NPI: | 1629006994 |
---|---|
Name: | HAMILTON-BRANDON, LUREDEAN GALE (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | LUREDEAN |
Middle Name: | GALE |
Last Name: | HAMILTON-BRANDON |
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: | 2365 SPRINGS RD NE |
Mailing Address - Street 2: | |
Mailing Address - City: | HICKORY |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28601-3067 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-256-2112 |
Mailing Address - Fax: | 828-256-2393 |
Practice Address - Street 1: | 2365 SPRINGS RD NE |
Practice Address - Street 2: | |
Practice Address - City: | HICKORY |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28601-3067 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-256-2112 |
Practice Address - Fax: | 828-256-2393 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-28 |
Last Update Date: | 2021-04-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 96-00185 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 135PH | Other | BCBS |
NC | 89135PH | Medicaid | |
NC | 2240903G | Medicare Oscar/Certification | |
NC | 89135PH | Medicaid | |
NC | 2240903H | Medicare Oscar/Certification | |
NC | G55041 | Medicare UPIN |