Provider Demographics
NPI:1104041300
Name:HAMLET MEDICAL CLINIC.P.A
Entity Type:Organization
Organization Name:HAMLET MEDICAL CLINIC.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BHARATKUMAR
Authorized Official - Middle Name:NATVERLAL
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-920-1579
Mailing Address - Street 1:400 KIMBERWICKE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7177
Mailing Address - Country:US
Mailing Address - Phone:910-920-1579
Mailing Address - Fax:
Practice Address - Street 1:400 KIMBERWICKE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-7177
Practice Address - Country:US
Practice Address - Phone:910-920-1579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7982447Medicaid
NC82447OtherBLUE CROSS BLUE SHIELD
NC110229797OtherRAILROAD MEDICARE
NCBT4281212OtherDEA NUMBER
NC2209607DMedicare ID - Type UnspecifiedMEDICARE
NC82447OtherBLUE CROSS BLUE SHIELD