Provider Demographics
NPI:1962621599
Name:HINE, MARY E (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:HINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4060 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1608
Mailing Address - Country:US
Mailing Address - Phone:619-280-4213
Mailing Address - Fax:619-280-3545
Practice Address - Street 1:7967 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1809
Practice Address - Country:US
Practice Address - Phone:619-741-7423
Practice Address - Fax:619-713-2589
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG53481207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG53481Medicaid
CAA93230Medicare UPIN