Provider Demographics
NPI:1669526190
Name:PRENTICE, HUGH JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:HUGH
Middle Name:JOHN
Last Name:PRENTICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 27957
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0957
Mailing Address - Country:US
Mailing Address - Phone:908-835-1910
Mailing Address - Fax:908-835-1924
Practice Address - Street 1:37 RUPELL RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-4017
Practice Address - Country:US
Practice Address - Phone:908-735-7060
Practice Address - Fax:908-735-9922
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1188503Medicaid
NJE77464Medicare UPIN
NJ1188503Medicaid