Provider Demographics
NPI:1780683763
Name:HAMILTON, CECELIA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:LYNN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37159 LANDINGS DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:SUITE 205
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-382-7072
Practice Address - Fax:216-691-3944
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062417207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH070013387OtherRAILROAD MEDICARE
OHHA0713873Medicare PIN
OHF24105Medicare UPIN
OHHA0713875Medicare PIN