Provider Demographics
NPI:1730251802
Name:DRS MININBERG & FECHTER PA
Entity type:Organization
Organization Name:DRS MININBERG & FECHTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-681-2683
Mailing Address - Street 1:10301 GEORGIA AVE
Mailing Address - Street 2:STE 105A
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5020
Mailing Address - Country:US
Mailing Address - Phone:301-681-2683
Mailing Address - Fax:301-681-1494
Practice Address - Street 1:10301 GEORGIA AVE
Practice Address - Street 2:STE 105A
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:301-681-2683
Practice Address - Fax:301-681-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC4768174400000X
MDD46443174400000X
CAG067028174400000X
MDD08092174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1147760001OtherDMERC
MDF56440Medicare UPIN
MD1147760001OtherDMERC
MD890327Medicare PIN
MDB93576Medicare UPIN