Provider Demographics
NPI:1770855454
Name:HAMILTON, MARTIN DALE SR (CRNP)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:DALE
Last Name:HAMILTON
Suffix:SR
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 BUTTERFIELD DR
Mailing Address - Street 2:ELKRID E
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6461
Mailing Address - Country:US
Mailing Address - Phone:301-310-5949
Mailing Address - Fax:
Practice Address - Street 1:9901 YORK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3407
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR150559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily