Healthcare Provider Details

I. General information

NPI: 1326087016
Provider Name (Legal Business Name): KRISTINA HINGRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 IRVING AVE SUITE 210
SYRACUSE NY
13210-1756
US

IV. Provider business mailing address

475 IRVING AVE SUITE 210
SYRACUSE NY
13210-1756
US

V. Phone/Fax

Practice location:
  • Phone: 315-471-2646
  • Fax: 315-471-1762
Mailing address:
  • Phone: 315-471-2646
  • Fax: 315-471-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number183523-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01350783
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: