Provider Demographics
NPI:1184641714
Name:MINTZ, RICHARD I (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:I
Last Name:MINTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7622 OGONTZ AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1817
Mailing Address - Country:US
Mailing Address - Phone:215-224-8980
Mailing Address - Fax:215-224-9342
Practice Address - Street 1:7622 OGONTZ AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1817
Practice Address - Country:US
Practice Address - Phone:215-224-8980
Practice Address - Fax:215-224-9342
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S003583L207R00000X, 207RC0000X
NJ25MB05998400207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0060155000OtherKE65
018210S003583LOtherHLTHD
018210S003583LOtherSRHP
0008238500001OtherDPA
0008238500005OtherDPA
0055111000OtherKE65
0060155000OtherPC
018210S003583LOtherHLTHP
P00087018OtherRRMED
0060155001OtherKEY
161767OtherBS
0060155000OtherPC65
1034655OtherKMHP
0055111000OtherPC65
0055111001OtherPC
01821OtherSRHP
161767OtherBLU
0055111000OtherKEY65
161767OtherBS
0055111001OtherPC