Provider Demographics
NPI:1467421065
Name:HUNT, JERRY BENSON (MD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:BENSON
Last Name:HUNT
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 1:2009 DRUID HILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3569
Mailing Address - Country:US
Mailing Address - Phone:410-669-0970
Mailing Address - Fax:410-669-0984
Practice Address - Street 1:2009 DRUID HILL AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3769
Practice Address - Country:US
Practice Address - Phone:410-669-0970
Practice Address - Fax:410-669-0984
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025373207R00000X
MDC25373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD338721600Medicaid
MDC29405Medicare ID - Type Unspecified
MD4339Medicare UPIN