MEDICARE: R. EDWARD MINER 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	207R00000X	Internal Medicine Physician	125942	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PREFERRED CARE	OTHER	NY	PREFERRED CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P010125942	OTHER	NY	BLUE CHOICE

General Provider Information

NPI Number	:	1790755361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	R. EDWARD MINER M.D.

Provider Business Mailing Address
First Line	:	30 HAGEN DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-2658
Country	:	US
Telephone Number	:	585-641-0400
Fax Number	:	585-641-0300

Provider Business Practice Location Address
First Line	:	30 HAGEN DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-2658
Country	:	US
Telephone Number	:	585-641-0400
Fax Number	:	585-641-0300

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	02/16/2011

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