Healthcare Provider Details

I. General information

NPI: 1447344775
Provider Name (Legal Business Name): GERALD MINGIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE MAIL STOP 320 FL
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE MAIL STOP 320 FL
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2194
  • Fax: 802-847-4937
Mailing address:
  • Phone: 802-847-2194
  • Fax: 802-847-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number255644
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number0420011293
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: