Provider Demographics
NPI:1275629230
Name:HINCKLEY, RALPH H (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:H
Last Name:HINCKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:WHITE 548
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-796-3937
Mailing Address - Fax:617-796-3938
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:WHITE 548
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-796-3937
Practice Address - Fax:617-796-3938
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25555207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0197661Medicaid
MAM04090Medicare ID - Type Unspecified
MAA65679Medicare UPIN