Provider Demographics
NPI:1013060466
Name:KAMINSKI, MITCHELL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:A
Last Name:KAMINSKI
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 1:259 N RADNOR CHESTER RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5288
Mailing Address - Country:US
Mailing Address - Phone:610-225-6226
Mailing Address - Fax:610-225-6225
Practice Address - Street 1:259 N RADNOR CHESTER RD
Practice Address - Street 2:SUITE 290
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5288
Practice Address - Country:US
Practice Address - Phone:610-225-6226
Practice Address - Fax:610-225-6225
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417217207Q00000X
NJ25MA09112500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD71543Medicare UPIN
PA053612Medicare PIN
PA001863949Medicaid