Provider Demographics
NPI:1073585873
Name:MINA, ALBERT CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CHARLES
Last Name:MINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N POINSETT HWY
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1667
Mailing Address - Country:US
Mailing Address - Phone:864-834-4151
Mailing Address - Fax:864-834-6145
Practice Address - Street 1:406 N POINSETT HWY
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1667
Practice Address - Country:US
Practice Address - Phone:864-834-4151
Practice Address - Fax:864-834-6145
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
207Q00000XOtherTAXONOMY
SC224974Medicaid
207Q00000XOtherTAXONOMY