Provider Demographics
NPI:1093251290
Name:HAMILTON, DONALD JEFFREY (PA-C)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JEFFREY
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 S RANDOLPH ST
Mailing Address - Street 2:277
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2245
Mailing Address - Country:US
Mailing Address - Phone:775-910-9656
Mailing Address - Fax:
Practice Address - Street 1:3000 S RANDOLPH ST
Practice Address - Street 2:277
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2245
Practice Address - Country:US
Practice Address - Phone:775-910-9656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1138794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant