Provider Demographics
NPI:1699746438
Name:MINN, MARY (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MINN
Suffix:
Gender:F
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:PO BOX 2057
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891
Mailing Address - Country:US
Mailing Address - Phone:401-596-7477
Mailing Address - Fax:401-596-0821
Practice Address - Street 1:25 WELLS ST
Practice Address - Street 2:THE WESTERLY HOSPITAL
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891
Practice Address - Country:US
Practice Address - Phone:401-348-3383
Practice Address - Fax:401-348-3792
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46898207L00000X, 208VP0014X
RIMD10092207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003105112OtherCT MEDICAID
050373266OtherTRICARE
RI7007372Medicaid
RI7007372Medicaid
RI007007372Medicare PIN