MEDICARE: DR. KENNETH WALTER MINTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0101X	Anatomic Pathology Physician	D0028651	MD

General Provider Information

NPI Number	:	1346432028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH WALTER MINTON M.D.

Provider Business Mailing Address
First Line	:	14101 ROBCASTE RD
Second Line	:
City	:	JACKSONVILLE
State	:	MD
Zip	:	21131-1471
Country	:	US
Telephone Number	:	301-455-5736
Fax Number	:	443-689-2175

Provider Business Practice Location Address
First Line	:	14101 ROBCASTE RD
Second Line	:
City	:	JACKSONVILLE
State	:	MD
Zip	:	21131-1471
Country	:	US
Telephone Number	:	13-455-5736
Fax Number	:	443-689-2175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	01/25/2019

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