Provider Demographics
NPI:1013070515
Name:HINES, EDWARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
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 1:1236 HUFFMAN MILL RD
Mailing Address - Street 2:SUITE1300
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8700
Mailing Address - Country:US
Mailing Address - Phone:336-584-5544
Mailing Address - Fax:336-584-4438
Practice Address - Street 1:1236 HUFFMAN MILL RD
Practice Address - Street 2:SUITE 1300
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-584-5544
Practice Address - Fax:336-584-4438
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC42508OtherBCBS OF NC
NC8942508Medicaid
NC4337OtherPARTNERS
NC8942508Medicaid