Provider Demographics
NPI:1831304880
Name:HAMADA, ALLISON KAZUE (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:KAZUE
Last Name:HAMADA
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 1:114 GATEWAY CORPORATE BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9785
Mailing Address - Country:US
Mailing Address - Phone:803-788-2277
Mailing Address - Fax:803-788-6508
Practice Address - Street 1:114 GATEWAY CORPORATE BLVD STE 350
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9785
Practice Address - Country:US
Practice Address - Phone:803-788-2277
Practice Address - Fax:803-788-6508
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93823207Q00000X
SC30551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC305510Medicaid
SC305510Medicaid