Provider Demographics
NPI:1669433769
Name:HAMRA, MARK W (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:HAMRA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-594-2195
Practice Address - Street 1:5231 JOHN TYLER HWY
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2553
Practice Address - Country:US
Practice Address - Phone:757-220-8300
Practice Address - Fax:757-565-5338
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-01-22
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Provider Licenses
StateLicense IDTaxonomies
VA0102831101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1669433769Medicaid
VA1669433769Medicaid