Provider Demographics
NPI:1245272905
Name:HYNES, MARY ANN
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:HYNES
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 1:6530 ROUTE 22
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-2414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6530 ROUTE 22
Practice Address - Street 2:SUITE 110
Practice Address - City:DELMONT
Practice Address - State:PA
Practice Address - Zip Code:15626-2414
Practice Address - Country:US
Practice Address - Phone:724-468-6477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037086E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
115164OtherBLUE SHIELD
PA001175039Medicaid
102562OtherUPMC HEALTH PLAN
P000594OtherGATEWAY HEALTH PLAN
110079453OtherRAILROAD MEDICARE
4057290OtherAETNA
110079453OtherRAILROAD MEDICARE
115164Medicare ID - Type Unspecified
102562OtherUPMC HEALTH PLAN