Provider Demographics
NPI:1881660181
Name:MINK, CLIFFORD E (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:E
Last Name:MINK
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 1:714 MAIN ST
Mailing Address - Street 2:SUITE 706A, BICKFORD HEALTH ASSOCIATES, PC
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2000
Mailing Address - Country:US
Mailing Address - Phone:508-362-1600
Mailing Address - Fax:508-362-1616
Practice Address - Street 1:714 MAIN ST
Practice Address - Street 2:SUITE 706A, BICKFORD HEALTH ASSOCIATES, PC
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2000
Practice Address - Country:US
Practice Address - Phone:508-362-1600
Practice Address - Fax:508-362-1616
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3189287Medicaid
MA080129869OtherRR MEDICARE
MA080129869OtherRR MEDICARE
MAA29027Medicare PIN