Provider Demographics
NPI:1548566730
Name:HAMMERBERG, EDWIN LAWRENCE (HIS)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:LAWRENCE
Last Name:HAMMERBERG
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BLACK HILL RD
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1062
Mailing Address - Country:US
Mailing Address - Phone:508-453-0444
Mailing Address - Fax:
Practice Address - Street 1:4 BLACK HILL RD
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1062
Practice Address - Country:US
Practice Address - Phone:508-453-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist