Provider Demographics
NPI:1245286590
Name:HINES, DIRK R (MD)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:R
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 1:4130 DRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45252-1914
Mailing Address - Country:US
Mailing Address - Phone:513-981-5162
Mailing Address - Fax:513-923-5522
Practice Address - Street 1:4130 DRY RIDGE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45252-1914
Practice Address - Country:US
Practice Address - Phone:513-981-5162
Practice Address - Fax:513-923-5522
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2172625Medicaid
OH4093178Medicare PIN
OHG01956Medicare UPIN