1073723334 NPI number — MARY T. KITAZONO HAMMELL MD

Table of content: MARY T. KITAZONO HAMMELL MD (NPI 1073723334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073723334 NPI number — MARY T. KITAZONO HAMMELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITAZONO HAMMELL
Provider First Name:
MARY
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KITAZONO
Provider Other First Name:
MARY
Provider Other Middle Name:
TSUTA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073723334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3674 ROUTE 27
Provider Second Line Business Mailing Address:
PRINCETON RADIOLOGY ASSOCIATES, P.A., DEPARTMENT B
Provider Business Mailing Address City Name:
KENDALL PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-821-5563
Provider Business Mailing Address Fax Number:
732-821-6675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3674 ROUTE 27
Provider Second Line Business Practice Location Address:
PRINCETON RADIOLOGY ASSOCIATES, P.A.., DEPARTMENT B
Provider Business Practice Location Address City Name:
KENDALL PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-821-5563
Provider Business Practice Location Address Fax Number:
732-821-6675
Provider Enumeration Date:
05/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  25MA09101800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)