Provider Demographics
NPI:1386764504
Name:HAMMER, CLARISA C (DO)
Entity type:Individual
Prefix:DR
First Name:CLARISA
Middle Name:C
Last Name:HAMMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 KENMORE AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1306
Mailing Address - Country:US
Mailing Address - Phone:703-832-4000
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:4660 KENMORE AVE STE 220
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1306
Practice Address - Country:US
Practice Address - Phone:703-832-4000
Practice Address - Fax:703-832-4001
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009035208600000X
CA20A10466208600000X
MDH75038208600000X
VA01022039162086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2760007Medicaid
MD334516500Medicaid
CA20A104660OtherBLUE SHIELD PROVIDER NUMBER
MD334516500Medicaid
CAAN732ZMedicare PIN
259973ZDWSMedicare PIN
OHHA7372491Medicare PIN
258976YBL9Medicare PIN