Provider Demographics
NPI:1033118203
Name:HUNTER, THEODORE M (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:M
Last Name:HUNTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 HAMILTON MASON RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8557
Mailing Address - Country:US
Mailing Address - Phone:513-867-0015
Mailing Address - Fax:513-867-8751
Practice Address - Street 1:3145 HAMILTON MASON RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-8557
Practice Address - Country:US
Practice Address - Phone:513-867-0015
Practice Address - Fax:513-867-8751
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043197H207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0428479Medicaid
OHCO1785Medicare UPIN
OHHU0473784Medicare PIN
OH0428479Medicaid