Provider Demographics
NPI:1790756971
Name:HAMRICK, ALGER VASON III (MD)
Entity Type:Individual
Prefix:
First Name:ALGER
Middle Name:VASON
Last Name:HAMRICK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 EXECUTIVE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7476
Mailing Address - Country:US
Mailing Address - Phone:919-875-0539
Mailing Address - Fax:919-875-1051
Practice Address - Street 1:3400 EXECUTIVE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7476
Practice Address - Country:US
Practice Address - Phone:919-875-0539
Practice Address - Fax:919-875-1051
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC88235Medicare UPIN
NC206971BMedicare ID - Type Unspecified
NC8938912Medicare ID - Type Unspecified