Provider Demographics
NPI:1275582264
Name:MINKIN, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:MINKIN
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 1:195 HOSPITAL LOOP
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9522
Mailing Address - Country:US
Mailing Address - Phone:802-229-9144
Mailing Address - Fax:
Practice Address - Street 1:195 HOSPITAL LOOP
Practice Address - Street 2:SUITE 7
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9522
Practice Address - Country:US
Practice Address - Phone:802-229-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010166207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2558Medicaid
VT100015260OtherRAILROAD MEDICARE
VT0VN2558Medicaid
VT100015260OtherRAILROAD MEDICARE