Provider Demographics
NPI:1518069954
Name:HOSTETTER, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HOSTETTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:90 TER HEUN DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2533
Mailing Address - Country:US
Mailing Address - Phone:508-540-0604
Mailing Address - Fax:508-457-0129
Practice Address - Street 1:90 TER HEUN DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2533
Practice Address - Country:US
Practice Address - Phone:508-540-0604
Practice Address - Fax:508-457-0129
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MA207724207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000029669OtherBOSTON MEDICAL CENTER
MAA32046OtherBLUE CROSS BLUE SHIELD
MAP00166554OtherMEDICARE ID
MA0038772OtherNEIGHBORHOOD HEALTH
MA207724OtherMA LICENSE
MA3501979OtherAETNA
MA465562OtherTUFTS
MAMH0541905AOtherMA CONTROLLED SUBSTANCE
MA043488655OtherTRICARE
MA0119369Medicaid
11456227OtherCAQH
MA1518069954OtherGREAT WEST HEALTHCARE
MA04-3488655OtherUNITED HEALTHCARE
MA1162585002OtherCIGNA
MA1518069954OtherUNICARE
MAAA15235OtherHARVARD PILGRIM
MA1518069954OtherNETWORK HEALTH
MA1518069954OtherNETWORK HEALTH
MAH31977Medicare UPIN
MA0038772OtherNEIGHBORHOOD HEALTH