Healthcare Provider Details

I. General information

NPI: 1841381530
Provider Name (Legal Business Name): JASON HOWARD HINES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLISEUM DR
HAMPTON VA
23666-5963
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 757-736-1000
  • Fax:
Mailing address:
  • Phone: 757-668-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0102201859
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102201859
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: