Provider Demographics
NPI:1215297882
Name:JEANTY, HAMERTON DAVID (MD)
Entity type:Individual
Prefix:
First Name:HAMERTON
Middle Name:DAVID
Last Name:JEANTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2209 GENESEE STREET
Mailing Address - Street 2:BUSINESS OFFICE ROOM 315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4830
Practice Address - Country:US
Practice Address - Phone:315-624-6829
Practice Address - Fax:315-624-6469
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2024-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY28707801207R00000X
NY287078208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04630695Medicaid