Provider Demographics
NPI:1134159858
Name:MINEROFF, ALLAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:DAVID
Last Name:MINEROFF
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BITTERSWEET DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2772
Mailing Address - Country:US
Mailing Address - Phone:215-489-0751
Mailing Address - Fax:215-489-0750
Practice Address - Street 1:1709 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1115
Practice Address - Country:US
Practice Address - Phone:215-362-5555
Practice Address - Fax:215-362-6353
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062839-L174400000X
PAMD015219E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01823658Medicaid
PA01823658Medicaid
PAG57860Medicare UPIN