Provider Demographics
NPI:1023058567
Name:HAMATY, FRED GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:GEORGE
Last Name:HAMATY
Suffix:
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9016
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:4731 ROUTE 30 STE 402
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7260
Practice Address - Country:US
Practice Address - Phone:724-552-0446
Practice Address - Fax:724-552-0445
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058303L207NI0002X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016538340008Medicaid
200459OtherHLTH AM/HEALTH ASSURANCE
PA1504877OtherGATEWAY
PA1000070OtherUPMC
PAG29080Medicare UPIN
PA83079OtherMED PLUS/UNISON
PA866033HXBMedicare ID - Type Unspecified