MEDICARE: MINERVA HEALTHCARE, PC

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	208D00000X	General Practice Physician	MD043486-L	PA

General Provider Information

NPI Number	:	1376712414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINERVA HEALTHCARE, PC

Provider Business Mailing Address
First Line	:	8501 WILLIAMS AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1912
Country	:	US
Telephone Number	:	215-242-2256
Fax Number	:	215-242-8833

Provider Business Practice Location Address
First Line	:	8501 WILLIAMS AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1912
Country	:	US
Telephone Number	:	215-242-2256
Fax Number	:	215-242-8833

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MARIA MILCU
Credential	:	MD
Telephone Number	:	215-242-2256

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/28/2008

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