Basic Information
| Provider Information | |||||||||
| NPI: | 1447539432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAINLINE | ||||||||
| FirstName: | CLOTILDE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 HARRISON AVE DOB 503 | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02118 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 725 ALBANY STREET | ||||||||
| Address2: | SHAPIRO 7, SUITE B | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176388456 | ||||||||
| FaxNumber: | 6176388465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2011 | ||||||||
| LastUpdateDate: | 10/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD2019-0676 | NM | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 265545 | MA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0109X | 265545 | MA | N | 207WX0109X | MD2019-0676 | NM | N | 2084N0400X | MD2019-0676 | NM | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 265545 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.