Provider Demographics
NPI:1396705596
Name:HAMILTON, GARRY A (MD)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:A
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:POCONO HEALTHCARE MANAGEMENT - PROFESSIONAL BLDG.
Mailing Address - City:E STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4951
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:175 E BROWN ST STE 108
Practice Address - Street 2:POCONO KIDS PEDIATRICS
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3098
Practice Address - Country:US
Practice Address - Phone:570-476-3585
Practice Address - Fax:570-421-9014
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD423683208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009373070001Medicaid
PA1009373070001Medicaid
PA078198PZPMedicare ID - Type Unspecified