Healthcare Provider Details

I. General information

NPI: 1982613659
Provider Name (Legal Business Name): BRIAN J HINES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 LONG RIDGE RD SUITE 202
STAMFORD CT
06902-1627
US

IV. Provider business mailing address

292 LONG RIDGE RD SUITE 202
STAMFORD CT
06902-1627
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-4524
  • Fax: 203-276-4525
Mailing address:
  • Phone: 203-276-4524
  • Fax: 203-276-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number040272
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: