Provider Demographics
NPI:1528296787
Name:STINE, NICHOLAS W (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:W
Last Name:STINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:185 BERRY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1773
Mailing Address - Country:US
Mailing Address - Phone:415-438-5579
Mailing Address - Fax:
Practice Address - Street 1:24 WILLIE MAYS PLZ
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-2134
Practice Address - Country:US
Practice Address - Phone:415-947-3096
Practice Address - Fax:415-292-3755
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA148040207R00000X
NY265091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine