Provider Demographics
NPI:1457440729
Name:HUTT, DOUGLAS A (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:HUTT
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 1:593 CRANBURY RD
Mailing Address - Street 2:STE 1A
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-613-8880
Mailing Address - Fax:732-613-0077
Practice Address - Street 1:593 CRANBURY RD
Practice Address - Street 2:STE 1A
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-613-8880
Practice Address - Fax:732-613-0077
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04602900207RC0200X, 207R00000X
NJ25MA046029207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLS104OtherOXFORD
NJ533777OtherAETNA USHC
NJ0650307Medicaid
NJHU566093Medicare ID - Type Unspecified
NJ0650307Medicaid