Provider Demographics
NPI:1073723334
Name:KITAZONO HAMMELL, MARY T (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:KITAZONO HAMMELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:TSUTA
Other - Last Name:KITAZONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3674 ROUTE 27
Mailing Address - Street 2:PRINCETON RADIOLOGY ASSOCIATES, P.A., DEPARTMENT B
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-821-5563
Mailing Address - Fax:732-821-6675
Practice Address - Street 1:3674 ROUTE 27
Practice Address - Street 2:PRINCETON RADIOLOGY ASSOCIATES, P.A.., DEPARTMENT B
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824
Practice Address - Country:US
Practice Address - Phone:732-821-5563
Practice Address - Fax:732-821-6675
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA091018002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ240262DVGMedicare PIN
NJ240262NUUMedicare PIN