Basic Information
| Provider Information | |||||||||
| NPI: | 1346229176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINNELLA | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 W ELM ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | CONSHOHOCKEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194282007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105676964 | ||||||||
| FaxNumber: | 6105676170 | ||||||||
| Practice Location | |||||||||
| Address1: | 831 PROVIDENCE RD | ||||||||
| Address2: | |||||||||
| City: | SECANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190182921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102844854 | ||||||||
| FaxNumber: | 6102844811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD037643 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0007456820006 | 05 | PA | MEDICAID | 17087 | 01 | PA | BLUE SHIELD | OTHER | 30034525 | 01 | PA | KMHP | OTHER | 0033020000 | 01 | PA | KHPE | OTHER | 1238929 | 01 | PA | AETNA HMO | OTHER |