Provider Demographics
NPI:1184218943
Name:HAMEL, MARK J
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:HAMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06330-1349
Mailing Address - Country:US
Mailing Address - Phone:860-333-0860
Mailing Address - Fax:
Practice Address - Street 1:186A MAIN ST
Practice Address - Street 2:
Practice Address - City:BALTIC
Practice Address - State:CT
Practice Address - Zip Code:06330-1349
Practice Address - Country:US
Practice Address - Phone:860-333-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207568182171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor