Provider Demographics
NPI:1477550671
Name:DINEEN, MARY KAY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:DINEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-594-2195
Practice Address - Street 1:12700 MCMANUS BLVD
Practice Address - Street 2:SUITE 102 A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4407
Practice Address - Country:US
Practice Address - Phone:757-874-8696
Practice Address - Fax:757-872-9904
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2009-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101034565207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1477550671Medicaid
VAP00670738Medicare PIN
VAB08931Medicare UPIN
VA1477550671Medicaid