Provider Demographics
NPI:1265458590
Name:HUTTON, JOHN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:HUTTON
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 1:218 D ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-3104
Mailing Address - Country:US
Mailing Address - Phone:304-720-3835
Mailing Address - Fax:866-408-1498
Practice Address - Street 1:218 D ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-3104
Practice Address - Country:US
Practice Address - Phone:304-720-3835
Practice Address - Fax:866-931-8591
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV101552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0115852000Medicaid
WVA71933Medicare UPIN
WV0115852000Medicaid
WVHU0419927Medicare PIN
WVHU0419928Medicare PIN
WVHU0419926Medicare PIN