Provider Demographics
NPI:1750489159
Name:HAMRICK, ROLAND EDWARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:EDWARD
Last Name:HAMRICK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 LEE ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2412
Mailing Address - Country:US
Mailing Address - Phone:304-343-2831
Mailing Address - Fax:304-343-2833
Practice Address - Street 1:1117 LEE ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2412
Practice Address - Country:US
Practice Address - Phone:304-343-2831
Practice Address - Fax:304-343-2833
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12003208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0128479000Medicaid
WV0128479000Medicaid
WVHA0528861Medicare ID - Type Unspecified