Provider Demographics
NPI:1023046224
Name:HAMILTON, MARK CONGDON (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CONGDON
Last Name:HAMILTON
Suffix:
Gender:M
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:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-0710
Mailing Address - Country:US
Mailing Address - Phone:802-886-2526
Mailing Address - Fax:802-886-2225
Practice Address - Street 1:368 RIVER STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2242
Practice Address - Country:US
Practice Address - Phone:802-886-2526
Practice Address - Fax:802-886-2225
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0005932207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99004682Medicaid
VT0004682Medicaid
NH99004682Medicaid
VT0004682Medicaid