Basic Information
| Provider Information | |||||||||
| NPI: | 1801865001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINTEER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 LEONARD AVE | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153013368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242233100 | ||||||||
| FaxNumber: | 7242233353 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 LEONARD AVE | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153013368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242233100 | ||||||||
| FaxNumber: | 7242233353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 01/21/2013 | ||||||||
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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 | 207Q00000X | MD021855E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QH0002X | MD021855E | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 63906 | 01 | UNISON | OTHER | 000408167 | 01 | HIGHMARK | OTHER | 100718 | 01 | UPMC | OTHER | 0010196240002 | 05 | PA | MEDICAID | P000414 | 01 | GATEWAY | OTHER |