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General NPI Number Information
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NPI Number | 1407859960
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Entity Type | Individual
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Provider Name | FREDRIC M MINTZER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1517 DURHAM RD
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City | PENNDEL
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State | PA
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Zip | 19047-5707
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Country | US
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Telephone | 215-752-1541
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Fax | 215-752-7195
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Provider Business Mailing Address
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Address Line | 4041 S WARNER RD
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City | LAFAYETTE HILL
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State | PA
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Zip | 19444-1421
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Country | US
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Telephone | 610-828-4428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD022742E
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License Number State | PA
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