Provider Demographics
NPI:1114085321
Name:HAMILTON, VALENTINE T (DPM)
Entity Type:Individual
Prefix:
First Name:VALENTINE
Middle Name:T
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 OFFICE PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3219
Mailing Address - Country:US
Mailing Address - Phone:910-938-6000
Mailing Address - Fax:910-938-3618
Practice Address - Street 1:29 OFFICE PARK DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3219
Practice Address - Country:US
Practice Address - Phone:910-938-6000
Practice Address - Fax:910-938-3618
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC222213EP1101X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908055Medicaid
08055OtherBCBS OF NC
NC8908055Medicaid
T64077Medicare UPIN
NC8908055Medicaid