Provider Demographics
NPI:1639380694
Name:SPAIN, MINTA PAMELA (MD)
Entity Type:Individual
Prefix:DR
First Name:MINTA
Middle Name:PAMELA
Last Name:SPAIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 1465
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10159-1465
Mailing Address - Country:US
Mailing Address - Phone:718-918-3886
Mailing Address - Fax:718-918-7526
Practice Address - Street 1:1400 PELHAM PARKWAY SOUTH
Practice Address - Street 2:NR 3N7
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-918-3886
Practice Address - Fax:718-918-7526
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY1923042084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry