1649238841 NPI number — JUDAH MINKOVE M.D.

Table of content: JUDAH MINKOVE M.D. (NPI 1649238841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649238841 NPI number — JUDAH MINKOVE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINKOVE
Provider First Name:
JUDAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1649238841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 FAIRMOUNT AVE STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21286-8518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-526-3042
Provider Business Mailing Address Fax Number:
410-584-1889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 MAIN ST STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REISTERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21136-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-526-3042
Provider Business Practice Location Address Fax Number:
410-584-1889
Provider Enumeration Date:
05/04/2006

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:  D27123 , 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: 32921100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com