Provider Demographics
NPI:1265489983
Name:MINO, ROBERT DAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAN
Last Name:MINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-0410
Mailing Address - Country:US
Mailing Address - Phone:484-530-0205
Mailing Address - Fax:484-530-0209
Practice Address - Street 1:3 VILLAGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-3812
Practice Address - Country:US
Practice Address - Phone:215-884-7114
Practice Address - Fax:215-884-7147
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038144E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011791810001Medicaid
PA0011791810001Medicaid
PA0011791810001Medicaid