Provider Demographics
NPI:1831241652
Name:HAMLET, KATHERINE RENEE (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RENEE
Last Name:HAMLET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SILVER BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-6011
Mailing Address - Country:US
Mailing Address - Phone:803-644-0100
Mailing Address - Fax:803-644-0110
Practice Address - Street 1:521 SILVER BLUFF RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6011
Practice Address - Country:US
Practice Address - Phone:803-644-0100
Practice Address - Fax:803-644-0110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19769207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571080342001OtherBLUE CROSS BLUE SHIELD
SC571080342001OtherBLUE CROSS BLUE SHIELD
SC6327Medicare ID - Type Unspecified