Provider Demographics
NPI:1013950294
Name:PINTO, MIMI H (DO)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:H
Last Name:PINTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4 NESHAMINY INTERPLEX
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6940
Mailing Address - Country:US
Mailing Address - Phone:215-244-3070
Mailing Address - Fax:215-638-9041
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0121952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2744908000OtherKHPE
PA9439954OtherPHCS
PA231955165OtherINTERGROUP SERVICES
PAOS012195OtherHEALTH PARTNERS
PA231955165OtherAETNA
PA2744908000OtherIBC
PAOS012195OtherMEDICAL LICENSE
PA101704005Medicaid
PA1883321OtherHIGHMARK BLUE SHIELD
PA30033402OtherKEYSTONE MERCY
PA10170400502OtherAMERICHOICE OF PA
PAPA7584OtherHEALTHNET
PA1883321OtherHIGHMARK BLUE SHIELD
PA231955165OtherINTERGROUP SERVICES