Provider Demographics
NPI:1073643268
Name:MINGUS, MELINDA LOU (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:LOU
Last Name:MINGUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:MINGUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:109 W 89TH ST
Mailing Address - Street 2:APT. 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1946
Mailing Address - Country:US
Mailing Address - Phone:646-522-1451
Mailing Address - Fax:212-874-3412
Practice Address - Street 1:109 W 89TH ST
Practice Address - Street 2:APT. 2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1946
Practice Address - Country:US
Practice Address - Phone:646-522-1451
Practice Address - Fax:212-874-3412
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159211207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60167Medicare UPIN
NY05E511Medicare ID - Type Unspecified