Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | OT014878 | PA |
N | 207Q00000X | Family Doctor | OT014878 | PA |
NPI | 1093095887 |
---|---|
Provider Name | Dr. Matthew William Hammond |
First Address | Philadelphia, PA 19114-4200 |
Second Address | Philadelphia, PA 19114-4200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2011 |
Last Update Date | 30/01/2013 |