Provider Demographics
NPI:1881662237
Name:MINKEN, STANLEY L (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:L
Last Name:MINKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:724 MAIDEN CHOICE LN
Mailing Address - Street 2:#203
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5917
Mailing Address - Country:US
Mailing Address - Phone:410-455-0200
Mailing Address - Fax:410-455-0009
Practice Address - Street 1:724 MAIDEN CHOICE LN
Practice Address - Street 2:#203
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-5917
Practice Address - Country:US
Practice Address - Phone:410-455-0200
Practice Address - Fax:410-455-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00119372086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD770002997Medicaid
MD770002997Medicaid
D74379Medicare UPIN