Provider Demographics
NPI:1134452733
Name:HAMMEL, TRACI JEAN
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:JEAN
Last Name:HAMMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 BOSTON ST STE 267
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5752
Mailing Address - Country:US
Mailing Address - Phone:305-588-3546
Mailing Address - Fax:
Practice Address - Street 1:3717 BOSTON ST STE 267
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5752
Practice Address - Country:US
Practice Address - Phone:305-588-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207750363LF0000X
MDR203078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily