Provider Demographics
NPI:1467468389
Name:HAMILL, ROBERT WALLACE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WALLACE
Last Name:HAMILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9354
Mailing Address - Country:US
Mailing Address - Phone:802-656-4588
Mailing Address - Fax:802-656-5678
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-656-4588
Practice Address - Fax:802-656-4588
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11890912084N0400X
VT042-00087252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0693Medicaid
VTOVN0693Medicaid
VTHAVN0693Medicare PIN