Provider Demographics
NPI:1558333500
Name:MINICK, GENEVIEVE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:M
Last Name:MINICK
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 1:4000 NEXUS DR STE E3
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:722 YORKLYN RD STE 400
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8740
Practice Address - Country:US
Practice Address - Phone:302-235-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418976207Q00000X
DEC1-0025386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019460030001Medicaid
PACC9269OtherRR MEDICARE GROUP
NY0237124Medicaid
PAGU039851OtherPA MEDICARE GROUP
PAP00010730OtherRR MEDICARE PIN
H79944Medicare UPIN
PA0019460030001Medicaid