Provider Demographics
NPI:1619996956
Name:HAMEROFF, STEPHEN B (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:HAMEROFF
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 1:100 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3416
Mailing Address - Country:US
Mailing Address - Phone:410-752-1677
Mailing Address - Fax:410-752-4435
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 225
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-653-0200
Practice Address - Fax:410-653-3667
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0006246207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
693LK286Medicare ID - Type Unspecified
B70148Medicare UPIN