Individual
DR. BRADLEY EVAN MINTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
(631) 686-7654
Mailing address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
(631) 686-7654
(631) 686-7653
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R73909
AZ
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
MD15438
RI
208M00000X
Hospitalist Physician
Primary
298678
NY
208M00000X
Hospitalist Physician
MD15438
RI
Other
Enumeration date
06/11/2013
Last updated
07/30/2021
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