Provider Demographics
NPI:1073774691
Name:HAMILTON, THANUJA K (MD)
Entity Type:Individual
Prefix:DR
First Name:THANUJA
Middle Name:K
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:204 ARK RD
Mailing Address - Street 2:SUITE 206 LMC I
Mailing Address - City:MT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-778-4640
Mailing Address - Fax:856-778-8862
Practice Address - Street 1:204 ARK ROAD
Practice Address - Street 2:SUITE 206 LMC I
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3100
Practice Address - Country:US
Practice Address - Phone:856-778-4640
Practice Address - Fax:856-778-8862
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440461207R00000X
NJ25MA09154300207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102643890-0001Medicaid
PA213836N4GMedicare PIN