Provider Demographics
NPI:1942295886
Name:MININSOHN, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:MININSOHN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:8813 WALTHAM WOODS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2450
Mailing Address - Country:US
Mailing Address - Phone:410-661-4060
Mailing Address - Fax:410-661-5349
Practice Address - Street 1:8813 WALTHAM WOODS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-2450
Practice Address - Country:US
Practice Address - Phone:410-661-4060
Practice Address - Fax:410-661-5349
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31189207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD378161500Medicaid
MD6104Medicare ID - Type Unspecified
B69635Medicare UPIN