Provider Demographics
NPI:1205928538
Name:HAMILTON, LAURA E (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 HARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LACONA
Mailing Address - State:NY
Mailing Address - Zip Code:13083-3101
Mailing Address - Country:US
Mailing Address - Phone:315-387-2456
Mailing Address - Fax:
Practice Address - Street 1:9677 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-8738
Practice Address - Country:US
Practice Address - Phone:315-668-3908
Practice Address - Fax:315-668-3946
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174341-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01080937Medicaid
NYDD2518Medicare ID - Type Unspecified
NY01080937Medicaid