Provider Demographics
NPI:1710903661
Name:HAMMERMAN, ALBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:M
Last Name:HAMMERMAN
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:PO BOX 411515
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-3515
Mailing Address - Country:US
Mailing Address - Phone:314-333-6750
Mailing Address - Fax:314-432-0178
Practice Address - Street 1:6520 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1706
Practice Address - Country:US
Practice Address - Phone:314-333-5777
Practice Address - Fax:314-333-5888
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR79882085R0202X
IL0360870122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300102476OtherRAILROAD MEDICARE NUMBER
300102472OtherRAILROAD MEDICARE NUMBER
MO202362703Medicaid
IL036087012Medicaid
MO003013061Medicare ID - Type UnspecifiedMO MEDICARE NUMBER
300102472OtherRAILROAD MEDICARE NUMBER
ILL28786Medicare ID - Type UnspecifiedIL MEDICARE NUMBER
IL036087012Medicaid
MO202362703Medicaid