Provider Demographics
NPI:1508893991
Name:HAMILTON, ALTHEA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ALTHEA
Middle Name:MARIE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 VERSTREET DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-4105
Mailing Address - Country:US
Mailing Address - Phone:585-730-8240
Mailing Address - Fax:585-730-8311
Practice Address - Street 1:980 WESTFALL RD
Practice Address - Street 2:STE 300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2605
Practice Address - Country:US
Practice Address - Phone:585-957-8502
Practice Address - Fax:585-957-8502
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05581600207L00000X
NY1672361207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD92047Medicare UPIN