Provider Demographics
NPI:1306959614
Name:VINES, DAIN (MD)
Entity type:Individual
Prefix:
First Name:DAIN
Middle Name:
Last Name:VINES
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:P O BOX 1119
Mailing Address - Street 2:
Mailing Address - City:HILLBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-1119
Mailing Address - Country:US
Mailing Address - Phone:919-245-3247
Mailing Address - Fax:919-732-3864
Practice Address - Street 1:400 MILLSTONE DRIVE
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9007
Practice Address - Country:US
Practice Address - Phone:919-245-3247
Practice Address - Fax:919-732-3864
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911275RMedicaid
NCH32209Medicare UPIN
NC2283986BMedicare ID - Type Unspecified