Provider Demographics
NPI:1427316348
Name:HUGH, JEREMY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:HUGH
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 1:1320 STONY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2206
Mailing Address - Country:US
Mailing Address - Phone:631-444-4200
Mailing Address - Fax:631-638-4220
Practice Address - Street 1:1320 STONY BROOK RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2206
Practice Address - Country:US
Practice Address - Phone:631-444-4200
Practice Address - Fax:631-638-4220
Is Sole Proprietor?:No
Enumeration Date:2012-04-28
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17511207N00000X
CODR.00588444207N00000X
NY314161207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000148091Medicaid
CO029226OtherKAISER COMMERCIAL NUMBER