Provider Demographics
NPI:1447320551
Name:MINGLE, A DAVID (MD)
Entity type:Individual
Prefix:
First Name:A
Middle Name:DAVID
Last Name:MINGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 WEST ELM STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428
Mailing Address - Country:US
Mailing Address - Phone:610-567-5387
Mailing Address - Fax:610-567-5224
Practice Address - Street 1:1930 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2328
Practice Address - Country:US
Practice Address - Phone:215-339-4747
Practice Address - Fax:610-271-9525
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD068537L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
045412Medicare ID - Type Unspecified
C56590Medicare UPIN