Provider Demographics
NPI:1104002203
Name:BUETTIN, ERIN HILTON (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:HILTON
Last Name:BUETTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WEST ST APT 32E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-3051
Mailing Address - Country:US
Mailing Address - Phone:540-931-7173
Mailing Address - Fax:
Practice Address - Street 1:30 WEST ST APT 32E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-3051
Practice Address - Country:US
Practice Address - Phone:540-931-7173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202402207R00000X
NY308454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC00085OtherMEDICARE GROUP
WV1104002203OtherMOUNTAIN STATE BLUE CROSS BLUE SHIELD
VA11956206OtherANTHEM BLUE SHIELD
VA1104002203Medicaid
VA021620W85Medicare PIN