Healthcare Provider Details

I. General information

NPI: 1063807329
Provider Name (Legal Business Name): DANA LYNN MINCER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 VIRGINIA DR STE 140
FORT WASHINGTON PA
19034-3106
US

IV. Provider business mailing address

1035 VIRGINIA DR STE 140
FORT WASHINGTON PA
19034-3106
US

V. Phone/Fax

Practice location:
  • Phone: 484-532-8812
  • Fax: 610-298-9138
Mailing address:
  • Phone: 484-532-8812
  • Fax: 610-298-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS019001
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number25MB10441900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: