Provider Demographics
NPI:1619947215
Name:HINES, SUSAN
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:
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 75216
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-0216
Mailing Address - Country:US
Mailing Address - Phone:336-783-6935
Mailing Address - Fax:336-783-6934
Practice Address - Street 1:865 W LAKE DR STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2135
Practice Address - Country:US
Practice Address - Phone:336-783-6935
Practice Address - Fax:336-783-6934
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-00229207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3097131OtherAETNA HMO
3608287OtherUNITED HEALTH CARE
37156OtherPARTNERS NATIONAL HEALTH
VA006005306Medicaid
4474243OtherAETNA PPO
NC126FMOtherBLUE CROSS BLUE SHIELD
NC89126FMMedicaid
900004457OtherRAILROAD MEDICARE
NC126FMOtherBLUE CROSS BLUE SHIELD
NC2280853BMedicare PIN
3608287OtherUNITED HEALTH CARE