Healthcare Provider Details

I. General information

NPI: 1346229176
Provider Name (Legal Business Name): JAMES M MINNELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 PROVIDENCE RD
SECANE PA
19018-2921
US

IV. Provider business mailing address

1 W ELM ST 2ND FLOOR
CONSHOHOCKEN PA
19428-2007
US

V. Phone/Fax

Practice location:
  • Phone: 610-284-4854
  • Fax: 610-284-4811
Mailing address:
  • Phone: 610-567-6964
  • Fax: 610-567-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD037643
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: