Provider Demographics
NPI:1033639703
Name:HINES, CISLEY CASSMIRRA (MD)
Entity type:Individual
Prefix:
First Name:CISLEY
Middle Name:CASSMIRRA
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 1:3902 KIPLING CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7683
Mailing Address - Country:US
Mailing Address - Phone:313-770-3391
Mailing Address - Fax:734-615-2964
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-2183
Practice Address - Fax:252-744-3616
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01095958A207ZP0102X
NC314621207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300106192Medicaid