Provider Demographics
NPI:1457387037
Name:HERSHEY, RICHARD HUTTON (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HUTTON
Last Name:HERSHEY
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 1:508 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:508 FOURTH ST
Practice Address - Street 2:THIS IS HOME ADDRESS PROVIDER IS RETIRED
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1901
Practice Address - Country:US
Practice Address - Phone:740-373-5772
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.036466208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0462052OtherMEDICARE PTAN
OH0396521Medicaid
OH0396521Medicaid
OHH535370Medicare PIN