Provider Demographics
NPI:1740397652
Name:GLENN D HAMILTON MD
Entity Type:Organization
Organization Name:GLENN D HAMILTON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-891-3900
Mailing Address - Street 1:1088 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE #2208
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5146
Mailing Address - Country:US
Mailing Address - Phone:610-891-3900
Mailing Address - Fax:610-891-3919
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:SUITE #2208
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5146
Practice Address - Country:US
Practice Address - Phone:610-891-3900
Practice Address - Fax:610-891-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty