Individual
MARY MINN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
46898
CT
207L00000X
Anesthesiology Physician
Primary
MD10092
RI
208VP0014X
Interventional Pain Medicine Physician
46898
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003105112
CT MEDICAID
CT
01
—
050373266
TRICARE
—
05
—
7007372
—
RI
Enumeration date
01/30/2006
Last updated
02/06/2023
Update your record
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