Provider Demographics
NPI:1982622676
Name:HAMMERMAN, MARC RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:RANDALL
Last Name:HAMMERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8126
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-7601
Mailing Address - Fax:314-362-0186
Practice Address - Street 1:4570 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1020
Practice Address - Country:US
Practice Address - Phone:314-362-7601
Practice Address - Fax:314-362-0186
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR7960207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0280272040Medicaid
MO054010183Medicaid
MO054010183Medicaid
MO390003362Medicare PIN