Provider Demographics
NPI:1285636662
Name:SINE, BETHEL (MD)
Entity Type:Individual
Prefix:
First Name:BETHEL
Middle Name:
Last Name:SINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 LAKE EAST DR
Mailing Address - Street 2:APT 2095
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2205
Mailing Address - Country:US
Mailing Address - Phone:408-230-8915
Mailing Address - Fax:
Practice Address - Street 1:9505 HILLWOOD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0506
Practice Address - Country:US
Practice Address - Phone:702-304-2144
Practice Address - Fax:702-304-2147
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506575Medicaid
IN453220OOMedicare PIN