Provider Demographics
NPI:1184626830
Name:MINOR, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MINOR
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 1:130 CARNIE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4521
Mailing Address - Country:US
Mailing Address - Phone:856-596-7440
Mailing Address - Fax:856-751-3320
Practice Address - Street 1:130 CARNIE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4521
Practice Address - Country:US
Practice Address - Phone:856-596-7440
Practice Address - Fax:856-751-3320
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01771700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2398001Medicaid
NJ029936Medicare ID - Type Unspecified
C56955Medicare UPIN