Provider Demographics
NPI:1316937162
Name:HUNT, CLARK CURTIS (MD)
Entity type:Individual
Prefix:
First Name:CLARK
Middle Name:CURTIS
Last Name:HUNT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:436 CLAREMONT CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1765
Mailing Address - Country:US
Mailing Address - Phone:804-526-2121
Mailing Address - Fax:804-520-2617
Practice Address - Street 1:436 CLAREMONT CT
Practice Address - Street 2:SUITE 100
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1765
Practice Address - Country:US
Practice Address - Phone:804-526-2121
Practice Address - Fax:804-520-2617
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101034457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316937162Medicaid
VA1316937162OtherBCBS
VAC35125Medicare UPIN
VA009296P80Medicare PIN