MEDICARE: DR. JAMES M MINNELLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD037643	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	17087	OTHER	PA	BLUE SHIELD
3	30034525	OTHER	PA	KMHP
4	0033020000	OTHER	PA	KHPE
5	1238929	OTHER	PA	AETNA HMO

General Provider Information

NPI Number	:	1346229176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M MINNELLA MD

Provider Business Mailing Address
First Line	:	1 W ELM ST
Second Line	:	2ND FLOOR
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2007
Country	:	US
Telephone Number	:	610-567-6964
Fax Number	:	610-567-6170

Provider Business Practice Location Address
First Line	:	831 PROVIDENCE RD
Second Line	:
City	:	SECANE
State	:	PA
Zip	:	19018-2921
Country	:	US
Telephone Number	:	610-284-4854
Fax Number	:	610-284-4811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	05/07/2008

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