Provider Demographics
NPI:1073576138
Name:MINDIKOGLU, AYSE LEYLA (MD)
Entity Type:Individual
Prefix:DR
First Name:AYSE
Middle Name:LEYLA
Last Name:MINDIKOGLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-1895
Mailing Address - Fax:410-328-1897
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-1895
Practice Address - Fax:410-328-1897
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7427207RG0100X
MDD62280207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407585400Medicaid
DE1073576138Medicaid
MD64874901OtherBLUE CROSS/BLUE SHIELD
DE1073576138Medicaid
MDL366Medicare PIN
I31385Medicare UPIN