1275780058 NPI number — TRACI ROCHELLE HAMILTON AUD

Table of content: TRACI ROCHELLE HAMILTON AUD (NPI 1275780058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275780058 NPI number — TRACI ROCHELLE HAMILTON AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMILTON
Provider First Name:
TRACI
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MICK
Provider Other First Name:
TRACI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275780058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 FRYE FARM RD STE 5
Provider Second Line Business Mailing Address:
CENTRAL MEDICAL ARTS BLDG.
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-7920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-539-3750
Provider Business Mailing Address Fax Number:
724-539-3751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 FRYE FARM RD STE 5
Provider Second Line Business Practice Location Address:
CENTRAL MEDICAL ARTS BLDG.
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-7920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-539-3750
Provider Business Practice Location Address Fax Number:
724-539-3751
Provider Enumeration Date:
08/22/2008

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: 231H00000X , with the licence number:  AT006084 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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