Provider Demographics
NPI:1841452539
Name:MARY ANN MINER, M.D., INC.
Entity type:Organization
Organization Name:MARY ANN MINER, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-401-8513
Mailing Address - Street 1:520 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1726
Mailing Address - Country:US
Mailing Address - Phone:650-348-9800
Mailing Address - Fax:650-401-8514
Practice Address - Street 1:520 S EL CAMINO REAL
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1726
Practice Address - Country:US
Practice Address - Phone:650-348-9800
Practice Address - Fax:650-401-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF16198Medicare PIN