Healthcare Provider Details

I. General information

NPI: 1275512162
Provider Name (Legal Business Name): BARRY A MINORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128-130 W MARKET ST
SCRANTON PA
18508-2641
US

IV. Provider business mailing address

128-130 W MARKET ST S
SCRANTON PA
18508-2641
US

V. Phone/Fax

Practice location:
  • Phone: 570-347-1177
  • Fax: 570-347-4691
Mailing address:
  • Phone: 570-347-1177
  • Fax: 570-347-4691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD056805L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001542747
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: