1295926830 NPI number — GINA G HUTTON M.D.

Table of content: GINA G HUTTON M.D. (NPI 1295926830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295926830 NPI number — GINA G HUTTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTTON
Provider First Name:
GINA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLENN
Provider Other First Name:
GINA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295926830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3445 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVENTRY TOWNSHIP
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44319-3028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-644-4095
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 N MAIN ST FL 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44310-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-379-8190
Provider Business Practice Location Address Fax Number:
330-379-8191
Provider Enumeration Date:
08/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  35089150 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2790878 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".