Healthcare Provider Details

I. General information

NPI: 1760838551
Provider Name (Legal Business Name): MICHELLE HINES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11890 HEALING WAY
SILVER SPRING MD
20904-7917
US

IV. Provider business mailing address

9901 MEDICAL CENTER DR
ROCKVILLE MD
20850-3357
US

V. Phone/Fax

Practice location:
  • Phone: 240-826-7488
  • Fax:
Mailing address:
  • Phone: 240-826-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0098524
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: