Provider Demographics
NPI:1053534446
Name:HAMLET PODIATRY, PC
Entity type:Organization
Organization Name:HAMLET PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REMBERT
Authorized Official - Middle Name:ALPHONSO
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:910-582-0007
Mailing Address - Street 1:P.O. BOX 2328
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28380-8328
Mailing Address - Country:US
Mailing Address - Phone:910-582-0007
Mailing Address - Fax:910-582-8070
Practice Address - Street 1:16 WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-2526
Practice Address - Country:US
Practice Address - Phone:910-582-0007
Practice Address - Fax:910-582-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC341213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08025OtherBCBS
NC890803MMedicaid
NC0803MMedicaid
NC5950762Medicaid
NC5950762Medicaid
NC2432586AMedicare PIN
NCU49109Medicare UPIN