Provider Demographics
NPI:1720130107
Name:MINOR, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
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 1:820 BRYAN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2409
Mailing Address - Country:US
Mailing Address - Phone:814-643-8474
Mailing Address - Fax:814-643-8477
Practice Address - Street 1:820 BRYAN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2409
Practice Address - Country:US
Practice Address - Phone:814-643-8474
Practice Address - Fax:814-643-8477
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044701L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251881378OtherUNITED HEALTH CARE
PA0072073720003Medicaid
PAMI674735OtherHIGHMARK
PA0072073720003Medicaid