Provider Demographics
NPI:1790773000
Name:HINES, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:HINES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:170 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8540
Mailing Address - Country:US
Mailing Address - Phone:704-360-2260
Mailing Address - Fax:704-360-2274
Practice Address - Street 1:170 MEDICAL PARK RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8540
Practice Address - Country:US
Practice Address - Phone:704-360-2260
Practice Address - Fax:704-360-2274
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2014-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200200234208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G74518Medicare UPIN
NC4689130001Medicare NSC
NC2005729AMedicare ID - Type Unspecified