Provider Demographics
NPI:1437139730
Name:HAMPL, MARC J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:J
Last Name:HAMPL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:J
Other - Last Name:HAMPL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:651-345-3321
Mailing Address - Fax:
Practice Address - Street 1:1202 5TH GRANT BLVD
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1042
Practice Address - Country:US
Practice Address - Phone:651-565-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9969363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN736114900Medicaid
MN970002208Medicare ID - Type Unspecified
MN736114900Medicaid