Provider Demographics
NPI:1205295565
Name:HAMILTON, MARK (BA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 E INTERNATIONAL AIRPORT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1409
Mailing Address - Country:US
Mailing Address - Phone:907-570-6382
Mailing Address - Fax:
Practice Address - Street 1:1205 E INTERNATIONAL AIRPORT RD STE 103
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1409
Practice Address - Country:US
Practice Address - Phone:907-570-6382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator