MEDICARE: MINA ESTAFANOS

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	NA	NY
2	183500000X	Pharmacist	24985	MD

General Provider Information

NPI Number	:	1851804777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA ESTAFANOS

Provider Business Mailing Address
First Line	:	8522 PINE RUN CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6934
Country	:	US
Telephone Number	:	917-929-7989
Fax Number	:

Provider Business Practice Location Address
First Line	:	8522 PINE RUN CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6934
Country	:	US
Telephone Number	:	917-929-7989
Fax Number	:

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

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	04/15/2024

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Directions to “ MINA ESTAFANOS ” Practice Location

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