Provider Demographics
NPI:1629013446
Name:HAMILL, RALPH C (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:C
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 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:4 GLEN COVE DR
Practice Address - Street 2:PEN BAY PHYSICIAN BUILDING
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4235
Practice Address - Country:US
Practice Address - Phone:207-596-6410
Practice Address - Fax:207-594-5183
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD11919207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
047606OtherANTHEM
ME115990099Medicaid
ME115990099Medicaid
MEP01035741Medicare PIN
047606OtherANTHEM
D03547Medicare UPIN
MEP01079155Medicare PIN
MEMM0261Medicare PIN