Provider Demographics
NPI:1366598989
Name:HINES, STELLA (MD)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:HINES
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-706-7464
Mailing Address - Fax:410-706-4078
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-706-7464
Practice Address - Fax:410-706-4078
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD71506207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS062-0413OtherCAREFIRST BC/BS
MD420339900Medicaid
MDS062-0413OtherCAREFIRST BC/BS
MD204407Y1PMedicare PIN
MDP00959564Medicare PIN