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NPI Code Detail

MEDICARE: VIVIAN MARIE MINKEMEYER M.D.

MEDICARE: VIVIAN MARIE MINKEMEYER M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
22085R0202XDiagnostic Radiology Physician2021-01121NC

General Provider Information

NPI Number : 1508391210
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIAN MARIE MINKEMEYER M.D.
Provider Business Mailing Address
First Line : 3949 BROWNING PL
Second Line :
City : RALEIGH
State : NC
Zip : 27609-6504
Country : US
Telephone Number : 919-787-7411
Fax Number :
Provider Business Practice Location Address
First Line : 3949 BROWNING PL
Second Line :
City : RALEIGH
State : NC
Zip : 27609-6504
Country : US
Telephone Number : 919-787-7411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2017
Last Update Date : 06/23/2026

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