1952965360 NPI number — MICHELLE YODER HAMILTON PHD

Table of content: MICHELLE YODER HAMILTON PHD (NPI 1952965360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952965360 NPI number — MICHELLE YODER HAMILTON PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMILTON
Provider First Name:
MICHELLE
Provider Middle Name:
YODER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YODER
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952965360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
814 SAINT CLAIR AVE APT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22902-4919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-221-7133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 REMSON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22901-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-923-8252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2019

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: 103TC0700X , with the licence number:  0810007478 , 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)

  • Identifier: 0810007478 . This is a "STATE LICENSING BOARD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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