Provider Demographics
NPI:1790381093
Name:HAMILTON, DANIEL RENE
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RENE
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:RENE
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-5124
Mailing Address - Country:US
Mailing Address - Phone:937-212-5821
Mailing Address - Fax:
Practice Address - Street 1:190 HIGH ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-5124
Practice Address - Country:US
Practice Address - Phone:937-212-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM2902161253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care