Provider Demographics
NPI:1811261803
Name:HAMILTON, JUSTIN DAVID (RPA-C)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DAVID
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5613 ROYAL TROON WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8147
Mailing Address - Country:US
Mailing Address - Phone:812-239-6662
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:INPATIENT ONCOLOGY PA SERVICE, #325
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-7576
Practice Address - Fax:646-962-0115
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY015395363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant