1689945073 NPI number — DR. NICOLAS DAVID HAMELIN MD

Table of content: DR. NICOLAS DAVID HAMELIN MD (NPI 1689945073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689945073 NPI number — DR. NICOLAS DAVID HAMELIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMELIN
Provider First Name:
NICOLAS
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689945073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 MONTARVILLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGUEUIL
Provider Business Mailing Address State Name:
QUEBEC
Provider Business Mailing Address Postal Code:
J4H 2L6
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
514-279-0749
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1510 SAN PABLO STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-5320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-7903
Provider Business Practice Location Address Fax Number:
323-442-6020
Provider Enumeration Date:
01/18/2012

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: 208200000X , with the licence number:  R12717 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: A121553 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1689945073 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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