Provider Demographics
NPI:1104002203
Name:BUETTIN, ERIN HILTON (DO)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:HILTON
Last Name:BUETTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 JOURNAL SQ STE E
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4006
Mailing Address - Country:US
Mailing Address - Phone:201-656-2300
Mailing Address - Fax:201-656-2390
Practice Address - Street 1:2 JOURNAL SQ STE E
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4006
Practice Address - Country:US
Practice Address - Phone:201-656-2300
Practice Address - Fax:201-656-2390
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202402207R00000X
NY308454207R00000X
NJ25MB12469100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11956206OtherANTHEM BLUE SHIELD
VAC00085OtherMEDICARE GROUP
WV1104002203OtherMOUNTAIN STATE BLUE CROSS BLUE SHIELD
VA1104002203Medicaid
VA021620W85Medicare PIN