Provider Demographics
NPI:1093782252
Name:MINTON, MARY JO R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:R
Last Name:MINTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8600 LASALLE RD
Mailing Address - Street 2:POTOMAC BUILDING SUITE 105
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2001
Mailing Address - Country:US
Mailing Address - Phone:410-823-5232
Mailing Address - Fax:410-296-0257
Practice Address - Street 1:8600 LASALLE RD
Practice Address - Street 2:POTOMAC BUILDING SUITE 105
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-2001
Practice Address - Country:US
Practice Address - Phone:410-823-5232
Practice Address - Fax:410-296-0257
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MDD00414282080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM32707OtherCDS
MDM32707OtherCDS
MDF97667Medicare UPIN