Provider Demographics
NPI:1043296015
Name:HINES, BRENDA (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
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 1:600 LAFAYETTE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-6006
Mailing Address - Country:US
Mailing Address - Phone:540-370-4380
Mailing Address - Fax:
Practice Address - Street 1:600 LAFAYETTE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-6006
Practice Address - Country:US
Practice Address - Phone:540-370-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231129207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010115434Medicaid
VA010115434Medicaid
F13276Medicare UPIN