Provider Demographics
NPI:1124120613
Name:HAMJIAN, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:HAMJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LYNXHOLM CT
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3019
Mailing Address - Country:US
Mailing Address - Phone:508-778-8585
Mailing Address - Fax:508-775-2951
Practice Address - Street 1:2 LYNXHOLM CT
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3019
Practice Address - Country:US
Practice Address - Phone:508-778-8585
Practice Address - Fax:508-775-2951
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA809802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3141993Medicaid
MAJ16097OtherBLUE SHIELD
MAJ16097OtherBLUE SHIELD
MAF33690Medicare UPIN