MEDICARE: RODERIC T HUNT RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	003597	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9511905	OTHER	NY	INDEPENDENT HEALTH
2	000570010006	OTHER	NY	BCBSWNY
3	00026518002	OTHER	NY	UNIVERA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346219656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODERIC T HUNT RPA-C

Provider Business Mailing Address
First Line	:	95 E CHAUTAUQUA ST
Second Line	:	PO BOX 168
City	:	MAYVILLE
State	:	NY
Zip	:	14757-0168
Country	:	US
Telephone Number	:	716-753-7107
Fax Number	:	716-753-7980

Provider Business Practice Location Address
First Line	:	95 E CHAUTAUQUA ST
Second Line	:
City	:	MAYVILLE
State	:	NY
Zip	:	14757-0168
Country	:	US
Telephone Number	:	716-753-7107
Fax Number	:	716-753-7980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	02/29/2012

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Directions to “ RODERIC T HUNT RPA-C” Practice Location

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