Provider Demographics
NPI:1619066040
Name:HINES, JONATHAN STEELE (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:STEELE
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 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-314-3300
Mailing Address - Fax:910-251-2066
Practice Address - Street 1:1202 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7307
Practice Address - Country:US
Practice Address - Phone:910-341-3336
Practice Address - Fax:910-251-2066
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110134652OtherRAILROAD MEDICARE
NC8942518Medicaid
NC42518OtherBCBS NC
NCG11890Medicare UPIN
NC8942518Medicaid
NC2229425Medicare PIN