Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 25MB10441900 | NJ |
Y | 207QA0401X | Family Doctor - Addiction Medicine | OS019001 | PA |
NPI | 1063807329 |
---|---|
Provider Name | Dana Lynn Mincer |
First Address | Glen Allen, VA 23060-9263 |
Second Address | Montgomeryville, PA 18936-9602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 14/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MB10441900 | (05) | NJ |