Provider Demographics
NPI:1861439002
Name:HAMILTON, MARY PAT (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:PAT
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:HAMILTON
Other - Last Name:VALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1953 SHEPHERDS STORE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-5510
Mailing Address - Country:US
Mailing Address - Phone:540-494-0505
Mailing Address - Fax:
Practice Address - Street 1:1953 SHEPHERDS STORE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-5510
Practice Address - Country:US
Practice Address - Phone:540-494-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32199207P00000X, 207PE0004X
WV26401207PE0004X
VA0101102768207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5881421Medicaid
7702Medicare PIN
VA5881421Medicaid