Provider Demographics
NPI:1376712414
Name:MINERVA HEALTHCARE, PC
Entity Type:Organization
Organization Name:MINERVA HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-242-2256
Mailing Address - Street 1:8501 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1912
Mailing Address - Country:US
Mailing Address - Phone:215-242-2256
Mailing Address - Fax:215-242-8833
Practice Address - Street 1:8501 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1912
Practice Address - Country:US
Practice Address - Phone:215-242-2256
Practice Address - Fax:215-242-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043486-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty