Provider Demographics
NPI:1689761009
Name:HAMILTON, TIMOTHY WADE (CO)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WADE
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9532 TWILIGHT CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1954
Mailing Address - Country:US
Mailing Address - Phone:301-497-1568
Mailing Address - Fax:
Practice Address - Street 1:2 WRAMC BUILDING 3H
Practice Address - Street 2:6900 GEORGIA AVE NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-6385
Practice Address - Fax:202-782-4365
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCC003725247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other