Provider Demographics
NPI:1447379367
Name:TAW, MINNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MINNIE
Middle Name:
Last Name:TAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-7575
Mailing Address - Fax:717-812-5154
Practice Address - Street 1:25 MONUMENT RD STE 105
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5049
Practice Address - Country:US
Practice Address - Phone:717-851-7575
Practice Address - Fax:717-812-5154
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225820207R00000X, 208000000X
PAMD436306207RB0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD960105OtherCAREFIRST MD BCBS-WMG
PA2091488OtherHIGHMARK BLUE SHIELD-WMG
PA293523OtherUNISON-WMG
PA30073073OtherAMERIHEALTH MERCY-WMG
PA998645OtherUPMC-WMG
PA151819FLTMedicare PIN