Provider Demographics
NPI:1578514352
Name:MINGEY, JOHN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:MINGEY
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 1:2501 W 12TH ST
Mailing Address - Street 2:STE C10
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4527
Mailing Address - Country:US
Mailing Address - Phone:814-461-6626
Mailing Address - Fax:814-871-6351
Practice Address - Street 1:2501 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4527
Practice Address - Country:US
Practice Address - Phone:814-461-6626
Practice Address - Fax:814-871-6351
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037038E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI105356Medicare ID - Type Unspecified
D70016Medicare UPIN