Basic Information
| Provider Information | |||||||||
| NPI: | 1225200025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMSHER | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | JON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 S TALBOT ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | ST MICHAELS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216632605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107450200 | ||||||||
| FaxNumber: | 8339082281 | ||||||||
| Practice Location | |||||||||
| Address1: | 933 S TALBOT ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | ST MICHAELS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216632605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107450200 | ||||||||
| FaxNumber: | 8339082281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2008 | ||||||||
| LastUpdateDate: | 10/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA051417 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | C03779 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.