Provider Demographics
NPI:1649201922
Name:MINTZER, JAMES HOWARD (DPM PC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HOWARD
Last Name:MINTZER
Suffix:
Gender:M
Credentials:DPM PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:012
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-269-4062
Mailing Address - Fax:202-832-2607
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:012
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-269-4062
Practice Address - Fax:202-832-2607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCP0402213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5423250001Medicare NSC
DC466623P58Medicare PIN
DC103258Medicare ID - Type Unspecified
DCT31252Medicare UPIN