Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD058303L | PA |
N | 207NS0135X | Procedural Dermatology | MD058303L | PA |
NPI | 1023058567 |
---|---|
Provider Name | Dr. Fred George Hamaty |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Greensburg, PA 15601-7260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 18/02/2021 |