MEDICARE: DR. JAMES W MINK MD

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	208000000X	Pediatrics Physician	0101040562	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	330034	OTHER	ANTHEM
3	541778786001	OTHER	TRICARE
4	006710948	OTHER	VA PREMIER
5	13841	OTHER	OPTIMA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	233006	OTHER	MDIPA/MAMSI

General Provider Information

NPI Number	:	1720026115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES W MINK MD

Provider Business Mailing Address
First Line	:	171 KEMPSVILLE RD
Second Line	:	BUILDING B
City	:	NORFOLK
State	:	VA
Zip	:	23502-4700
Country	:	US
Telephone Number	:	757-668-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 KEMPSVILLE RD
Second Line	:	BUILDING B
City	:	NORFOLK
State	:	VA
Zip	:	23502-4700
Country	:	US
Telephone Number	:	757-668-6500
Fax Number	:

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/04/2013

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