Provider Demographics
NPI:1689945073
Name:HAMELIN, NICOLAS DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:DAVID
Last Name:HAMELIN
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 1:205 MONTARVILLE
Mailing Address - Street 2:
Mailing Address - City:LONGUEUIL
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:J4H 2L6
Mailing Address - Country:CA
Mailing Address - Phone:514-279-0749
Mailing Address - Fax:
Practice Address - Street 1:1510 SAN PABLO STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-442-7903
Practice Address - Fax:323-442-6020
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZR12717208200000X
CAA121553208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689945073Medicaid
CAGE938ZMedicare PIN