Provider Demographics
NPI:1063498152
Name:VINE, HUGH S (MD)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:S
Last Name:VINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:111 FOUNDERS PLZ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3212
Mailing Address - Country:US
Mailing Address - Phone:860-291-6554
Mailing Address - Fax:860-528-0778
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-289-3375
Practice Address - Fax:860-560-2849
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2009-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT0242002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001242007Medicaid
CTA2516306OtherOXFORD
CT010024200CT01OtherANTHEM BC/BS
CT300000679Medicare ID - Type Unspecified
CT001242007Medicaid