Provider Demographics
NPI:1801934799
Name:HAMMACK, STACEY A (PA)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:HAMMACK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6420 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7837
Mailing Address - Country:US
Mailing Address - Phone:301-571-0019
Mailing Address - Fax:301-571-0988
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:SUITE 4100
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:301-571-0019
Practice Address - Fax:301-571-0988
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002710363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical