Provider Demographics
NPI:1578506531
Name:HINES, RICHARD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:HINES
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:PO BOX 1029
Mailing Address - Street 2:BLUE HILL FAMILY MEDICINE
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-1029
Mailing Address - Country:US
Mailing Address - Phone:207-374-2311
Mailing Address - Fax:
Practice Address - Street 1:65 WATER ST
Practice Address - Street 2:SUSSMAN OFFICE BUILDING
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-5231
Practice Address - Country:US
Practice Address - Phone:207-374-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME303720099Medicaid
ME303720099Medicaid
MEMM0366Medicare PIN
MEMM036601Medicare PIN