Basic Information
| Provider Information | |||||||||
| NPI: | 1033118203 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUNTER | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3145 HAMILTON MASON RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450118557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138670015 | ||||||||
| FaxNumber: | 5138678751 | ||||||||
| Practice Location | |||||||||
| Address1: | 3145 HAMILTON MASON RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450118557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138670015 | ||||||||
| FaxNumber: | 5138678751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 04/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35043197H | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0428479 | 05 | OH | MEDICAID |