Provider Demographics
NPI:1780638387
Name:HAMILTON, MADELYN (NP)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NP
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 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-479-2546
Mailing Address - Fax:802-479-1346
Practice Address - Street 1:14 N MAIN ST STE 4002
Practice Address - Street 2:GRANITE CITY PRIMARY CARE
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4513
Practice Address - Country:US
Practice Address - Phone:802-479-2546
Practice Address - Fax:802-479-1346
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010017211363LW0102X
VT101-0017211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTONP1399Medicaid
VTONP1399Medicaid
VTNP139901Medicare PIN
VTNP1399Medicare UPIN
VTS73641Medicare UPIN