1033316096 NPI number — DR. CHELSEA DAWN HAMILTON M.D.

Table of content: DR. CHELSEA DAWN HAMILTON M.D. (NPI 1033316096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033316096 NPI number — DR. CHELSEA DAWN HAMILTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMILTON
Provider First Name:
CHELSEA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRUNDAGE
Provider Other First Name:
CHELSEA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033316096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15626 HABITAT CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22193-1135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-556-3685
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 DEWITT LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT BELVOIR
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22060-5285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-231-1363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2007

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: 208100000X , with the licence number:  0101244437 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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