Provider Demographics
NPI:1568636348
Name:HAMILTON, ELAINE S (RD)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:S
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:S
Other - Last Name:SCHWEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:500 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-2508
Mailing Address - Country:US
Mailing Address - Phone:860-249-9625
Mailing Address - Fax:
Practice Address - Street 1:500 ALBANY AVE
Practice Address - Street 2:COMMUNITY HEALTH SERVICES
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120
Practice Address - Country:US
Practice Address - Phone:860-249-9625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
CT913937133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA913937OtherCDR CERTIFICATION
MA1310097Medicaid
MAM21172Medicare PIN
MA913937OtherCDR CERTIFICATION