Healthcare Provider Details

I. General information

NPI: 1578506531
Provider Name (Legal Business Name): RICHARD G. HINES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WATER ST SUSSMAN OFFICE BUILDING
BLUE HILL ME
04614-5231
US

IV. Provider business mailing address

PO BOX 1029 BLUE HILL FAMILY MEDICINE
BLUE HILL ME
04614-1029
US

V. Phone/Fax

Practice location:
  • Phone: 207-374-2311
  • Fax:
Mailing address:
  • Phone: 207-374-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011869
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: