MEDICARE: MARK DOUGLAS HINTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PD000041	PA
2	174400000X	Specialist	OH000027	PA
3	174400000X	Specialist	PO000010	PA

General Provider Information

NPI Number	:	1225569809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK DOUGLAS HINTON

Provider Business Mailing Address
First Line	:	3500 6TH AVE
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-1814
Country	:	US
Telephone Number	:	814-944-0187
Fax Number	:	814-942-1712

Provider Business Practice Location Address
First Line	:	3500 6TH AVE
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-1814
Country	:	US
Telephone Number	:	814-944-0187
Fax Number	:	814-942-1712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	03/24/2017

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Directions to “ MARK DOUGLAS HINTON ” Practice Location

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