Provider Demographics
NPI:1275512162
Name:MINORA, BARRY A (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:MINORA
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 1:128-130 W MARKET ST
Mailing Address - Street 2:S
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2641
Mailing Address - Country:US
Mailing Address - Phone:570-347-1177
Mailing Address - Fax:570-347-4691
Practice Address - Street 1:128-130 W MARKET ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2641
Practice Address - Country:US
Practice Address - Phone:570-347-1177
Practice Address - Fax:570-347-4691
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056805L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001542747Medicaid
PA001542747Medicaid
PA172076Medicare PIN