Provider Demographics
NPI:1831181965
Name:MINEHAN, THOMAS F (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:MINEHAN
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 1:309 COUNTY ROUTE 47
Mailing Address - Street 2:STE 4
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-5405
Mailing Address - Country:US
Mailing Address - Phone:518-891-1610
Mailing Address - Fax:518-891-5726
Practice Address - Street 1:309 COUNTY ROUTE 47
Practice Address - Street 2:STE 4
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5405
Practice Address - Country:US
Practice Address - Phone:518-891-1610
Practice Address - Fax:518-891-5726
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00484840Medicaid
NY00484840Medicaid
B80708Medicare UPIN