Provider Demographics
NPI:1982672473
Name:HENIN, NEVINE (MD)
Entity Type:Individual
Prefix:
First Name:NEVINE
Middle Name:
Last Name:HENIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:525 LONG POND DRIVE
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645
Practice Address - Country:US
Practice Address - Phone:508-432-4100
Practice Address - Fax:508-432-8951
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA159221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA710666OtherHPHC
MA3198413Medicaid
MAJ21218OtherBCBS
MA710666OtherHPHC
G92980Medicare UPIN