Provider Demographics
NPI:1619985314
Name:PINKUS, HARRY E (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:E
Last Name:PINKUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13505 CITICARDS WAY UNIT 4302
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-6539
Mailing Address - Country:US
Mailing Address - Phone:207-522-2990
Mailing Address - Fax:
Practice Address - Street 1:15 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-3764
Practice Address - Country:US
Practice Address - Phone:207-522-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME571052085N0700X, 2085R0202X, 2085R0202X
NJ25MA081358002085N0700X, 2085R0202X
VA01018404612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E79513Medicare UPIN