Provider Demographics
NPI:1225569809
Name:HINTON, MARK DOUGLAS
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DOUGLAS
Last Name:HINTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1814
Mailing Address - Country:US
Mailing Address - Phone:814-944-0187
Mailing Address - Fax:814-942-1712
Practice Address - Street 1:3500 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1814
Practice Address - Country:US
Practice Address - Phone:814-944-0187
Practice Address - Fax:814-942-1712
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPD000041174400000X
PAOH000027174400000X
PAPO000010174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1266670001Medicare NSC
PA1266670003Medicare NSC
PA1266670002Medicare NSC