Healthcare Provider Details

I. General information

NPI: 1972582195
Provider Name (Legal Business Name): CORRADO MINIMO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD TOWER BUILDING, GRND. FLOOR
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

5501 OLD YORK ROAD TOWER BUILDING, GRND. FLOOR
PHILADELPHIA PA
19141
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-6157
  • Fax:
Mailing address:
  • Phone: 215-456-6157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD0703417L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: