1285737775 NPI number — MS. KRYSTINA M MINTS CRNP

Table of content: MS. KRYSTINA M MINTS CRNP (NPI 1285737775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285737775 NPI number — MS. KRYSTINA M MINTS CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINTS
Provider First Name:
KRYSTINA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285737775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 MOUNTAIN RD
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21122-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-360-4446
Provider Business Mailing Address Fax Number:
410-360-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21122-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-360-4446
Provider Business Practice Location Address Fax Number:
410-360-4449
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  R160139 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 521116591 . This is a "COVENTRY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 521116591 . This is a "MARYLAND PHYSICIANS CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 759524 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T5880038 . This is a "CF BC/BS GRP/GHMSI/BL CHO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 521116591 . This is a "INFORMED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6560084 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 112728 . This is a "PRIORITY PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 61308701 . This is a "CAREFIRST BC/BS RENDERING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 521116591 . This is a "TRICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 784381000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: W6420009 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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