Provider Demographics
NPI:1235233784
Name:HINERMAN, RAYMOND A (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:HINERMAN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1660
Mailing Address - Country:US
Mailing Address - Phone:304-221-4541
Mailing Address - Fax:
Practice Address - Street 1:30 MEDICAL PARK STE 223
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6391
Practice Address - Country:US
Practice Address - Phone:304-234-2060
Practice Address - Fax:304-234-2070
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21809207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001769Medicaid
VA1235233784Medicaid
WV3810001769Medicaid
VA1235233784Medicaid
I26095Medicare UPIN
VA021063A09Medicare PIN