Provider Demographics
NPI:1972559862
Name:HINES DERMATOLOGY ASSOCIATES, INC.
Entity type:Organization
Organization Name:HINES DERMATOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-222-1976
Mailing Address - Street 1:555 PLEASANT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2400
Mailing Address - Country:US
Mailing Address - Phone:508-222-1976
Mailing Address - Fax:508-226-9619
Practice Address - Street 1:555 PLEASANT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2400
Practice Address - Country:US
Practice Address - Phone:508-222-1976
Practice Address - Fax:508-226-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9777857Medicaid
MA9777857Medicaid