Provider Demographics
NPI:1427037530
Name:HAMACHER, KIRSTEN LYN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:LYN
Last Name:HAMACHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:K.
Other - Middle Name:LYN
Other - Last Name:HAMACHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 42210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-2210
Mailing Address - Country:US
Mailing Address - Phone:623-266-7770
Mailing Address - Fax:623-322-4639
Practice Address - Street 1:424 S 56TH ST STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2177
Practice Address - Country:US
Practice Address - Phone:602-685-5211
Practice Address - Fax:602-685-5325
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35883207N00000X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ137670Medicaid
AZP00367464OtherRAILROAD MEDICARE
MN031635100Medicaid
AZP00367464OtherRAILROAD MEDICARE
H47871Medicare UPIN
MN031635100Medicaid
AZ120303Medicare PIN
MN070016065Medicare ID - Type UnspecifiedRAILROAD
AZ137607Medicaid