Provider Demographics
NPI:1265494389
Name:MINTZ, PAUL SANDER (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SANDER
Last Name:MINTZ
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 1:200 READING BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2236
Mailing Address - Country:US
Mailing Address - Phone:610-223-8287
Mailing Address - Fax:610-374-9246
Practice Address - Street 1:200 READING BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2236
Practice Address - Country:US
Practice Address - Phone:610-223-8287
Practice Address - Fax:610-374-9246
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030435E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010075800001Medicaid
B36691Medicare UPIN
PA0010075800001Medicaid