Provider Demographics
NPI:1790854412
Name:ERIC K HAMMERBERG MD PC
Entity Type:Organization
Organization Name:ERIC K HAMMERBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAMMERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-825-3759
Mailing Address - Street 1:4485 WADSWORTH BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3318
Mailing Address - Country:US
Mailing Address - Phone:303-825-3759
Mailing Address - Fax:303-825-7003
Practice Address - Street 1:4485 WADSWORTH BLVD
Practice Address - Street 2:STE 301
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3318
Practice Address - Country:US
Practice Address - Phone:303-825-3759
Practice Address - Fax:303-825-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO165892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO40689OtherINDIVIDUAL PTAN
HA38551OtherBCBS
CO01165893Medicaid
COCOB4381OtherGROUP PTAN
COCO40689OtherINDIVIDUAL PTAN
COCOB4381OtherGROUP PTAN