Provider Demographics
NPI:1780854968
Name:JOHN R. HAMILL, JR., M.D., LLC
Entity Type:Organization
Organization Name:JOHN R. HAMILL, JR., M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-657-0802
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 675
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-657-0802
Mailing Address - Fax:301-657-0803
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 675
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-657-0802
Practice Address - Fax:301-657-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015159207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01079Medicare PIN