Provider Demographics
NPI:1316915572
Name:HAMILTON, RUSSELL W JR (DPM)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:W
Last Name:HAMILTON
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2721
Mailing Address - Country:US
Mailing Address - Phone:978-256-8900
Mailing Address - Fax:978-256-8972
Practice Address - Street 1:9 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2721
Practice Address - Country:US
Practice Address - Phone:978-256-8900
Practice Address - Fax:978-256-8972
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1603213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
333051OtherHARVARD PILGRIM
MAY70690OtherBLUE SHIELD
98193401OtherNETWORK HEALTH
700378OtherTUFTS
MA0341479Medicaid
2700129OtherEVERCARE
MAY70690OtherBLUE SHIELD
2700129OtherEVERCARE