Provider Demographics
NPI:1932155520
Name:MINOR, BRENDA CAROL (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:CAROL
Last Name:MINOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 HUTCHINSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3783
Mailing Address - Country:US
Mailing Address - Phone:978-774-7171
Mailing Address - Fax:978-739-6930
Practice Address - Street 1:ONE HUTCHINSON DR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-739-6950
Practice Address - Fax:978-777-9274
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-02-13
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Provider Licenses
StateLicense IDTaxonomies
MA49522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6195075Medicaid
MA6195075Medicaid
A58004Medicare UPIN