Provider Demographics
NPI:1154552651
Name:STINE, PATRICK HERVEY (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:HERVEY
Last Name:STINE
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 1:2195 S BINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:VT
Mailing Address - Zip Code:05778-9508
Mailing Address - Country:US
Mailing Address - Phone:802-462-2012
Mailing Address - Fax:
Practice Address - Street 1:2195 S BINGHAM ST
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:VT
Practice Address - Zip Code:05778-9508
Practice Address - Country:US
Practice Address - Phone:802-462-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0162207Y00000X
VT042-0006468207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology