Provider Demographics
NPI:1689080806
Name:HUNTER, MARK (CSA,RSA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HUNTER
Suffix:
Gender:M
Credentials:CSA,RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 MARSHALL RUN CIR APT 207
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5865
Mailing Address - Country:US
Mailing Address - Phone:804-306-5514
Mailing Address - Fax:
Practice Address - Street 1:9600 SPRING GLEN DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8829
Practice Address - Country:US
Practice Address - Phone:804-306-5514
Practice Address - Fax:804-275-7574
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3909246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant