Provider Demographics
NPI:1780904128
Name:HAMILTON, HEIDI HENDRICKER (MD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:HENDRICKER
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:JANE
Other - Last Name:HENDRICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:165 ASHLEY AVE
Mailing Address - Street 2:STE 309, MSC908
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:169 ASHLEY AVE
Practice Address - Street 2:ROOM 202 MAIN HOSPITAL, MSC333
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8905
Practice Address - Country:US
Practice Address - Phone:843-792-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMMD.32653 LL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology