Healthcare Provider Details

I. General information

NPI: 1578508149
Provider Name (Legal Business Name): ALFIE EDWARD MINGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3595
US

IV. Provider business mailing address

8118 GOOD LUCK RD
LANHAM MD
20706-3595
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8665
  • Fax: 301-552-8665
Mailing address:
  • Phone: 301-552-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0060545
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301098748
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: