Provider Demographics
NPI:1457915654
Name:HAMILTON, DERRICK L (QMHS)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 ROCKSPRING RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1642
Mailing Address - Country:US
Mailing Address - Phone:419-699-1830
Mailing Address - Fax:
Practice Address - Street 1:2236 ROCKSPRING RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1642
Practice Address - Country:US
Practice Address - Phone:419-699-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator