Provider Demographics
NPI:1992993976
Name:JAMES H. MINTZER, DPM PC
Entity type:Organization
Organization Name:JAMES H. MINTZER, DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:MINTZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:202-269-4062
Mailing Address - Street 1:1160 VARNUM ST NE STE 12
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2110
Mailing Address - Country:US
Mailing Address - Phone:202-269-4062
Mailing Address - Fax:
Practice Address - Street 1:1160 VARNUM ST NE STE 12
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2110
Practice Address - Country:US
Practice Address - Phone:202-269-4062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCP0402213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCT31252Medicare UPIN
DC5423250001Medicare NSC