1386622157 NPI number — NATALY MINKINA MD

Table of content: NATALY MINKINA MD (NPI 1386622157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386622157 NPI number — NATALY MINKINA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINKINA
Provider First Name:
NATALY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1386622157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 INDEPENDENCE DR
Provider Second Line Business Mailing Address:
INTERNAL MEDICINE
Provider Business Mailing Address City Name:
CHESTNUT HILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02467-3628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-541-6505
Provider Business Mailing Address Fax Number:
617-541-6444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 BOYLSTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTNUT HILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02467-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-732-9900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2006

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: 207R00000X , with the licence number:  160133 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0121291 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0410481 . This is a "UNITED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3690018 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7975828-008 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 160133 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 69891 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J22762 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com