Provider Demographics
NPI:1447344775
Name:MINGIN, GERALD (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:MINGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:MAIL STOP 320 FL
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-2194
Mailing Address - Fax:802-847-4937
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:MAIL STOP 320 FL
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2194
Practice Address - Fax:802-847-4937
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2556442088P0231X
VT04200112932088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013484Medicaid
NY02881001Medicaid
NH30207298Medicaid
VT000059501Medicare PIN
NH30207298Medicaid