Provider Demographics
NPI:1851319297
Name:MINTO, OLETHA ROSINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:OLETHA
Middle Name:ROSINA
Last Name:MINTO
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 1:410 UNIVERSITY PARKWAY
Mailing Address - Street 2:SUITE 1550
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801
Mailing Address - Country:US
Mailing Address - Phone:803-649-7535
Mailing Address - Fax:803-648-8771
Practice Address - Street 1:410 UNIVERSITY PARKWAY
Practice Address - Street 2:SUITE 1550
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-649-7535
Practice Address - Fax:803-648-8771
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCT7345207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT73453Medicaid
H57224Medicare UPIN
SCH572241757Medicare PIN