Provider Demographics
NPI:1255360475
Name:CHARLES M. HINES, M.D., P.C.
Entity type:Organization
Organization Name:CHARLES M. HINES, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-531-1158
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01011-0384
Mailing Address - Country:US
Mailing Address - Phone:413-531-1158
Mailing Address - Fax:
Practice Address - Street 1:101 INGELL ROAD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MA
Practice Address - Zip Code:01011
Practice Address - Country:US
Practice Address - Phone:413-531-1158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77820207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9730401Medicaid
MAM18336OtherBCBS
MAM18336OtherBCBS
MAD86818Medicare UPIN