Provider Demographics
NPI:1619947215
Name:HINES, SUSAN JEAN
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JEAN
Last Name:HINES
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1908 CAUDLE DR STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4322
Practice Address - Country:US
Practice Address - Phone:336-783-6935
Practice Address - Fax:336-783-6934
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-00229207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126FMMedicaid
37156OtherPARTNERS NATIONAL HEALTH
VA006005306Medicaid
NC126FMOtherBLUE CROSS BLUE SHIELD
900004457OtherRAILROAD MEDICARE
4474243OtherAETNA PPO
3097131OtherAETNA HMO
3608287OtherUNITED HEALTH CARE
NC126FMOtherBLUE CROSS BLUE SHIELD
NC2280853BMedicare PIN
3608287OtherUNITED HEALTH CARE