Provider Demographics
NPI:1013260355
Name:MINNECI, COLT
Entity Type:Individual
Prefix:
First Name:COLT
Middle Name:
Last Name:MINNECI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8B NUTMEG KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:COCKYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030
Mailing Address - Country:US
Mailing Address - Phone:847-275-7800
Mailing Address - Fax:
Practice Address - Street 1:8 NUTMEG KNOLL CT APT B
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4335
Practice Address - Country:US
Practice Address - Phone:847-275-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist