Provider Demographics
NPI:1093827420
Name:HUNTER, ROBERTA J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:J
Last Name:HUNTER
Suffix:
Gender:F
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:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5507
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:2930 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-351-1700
Practice Address - Fax:304-351-1725
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056623207RG0100X
WV31980207RG0100X
OH35-086695207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0244633Medicaid
OH2793928Medicaid
VA010244633Medicaid
OHHU4221721Medicare PIN
OH4221723Medicare PIN
VA010244633Medicaid
OHF63485Medicare UPIN
010034M36Medicare ID - Type Unspecified