Provider Demographics
NPI:1760477046
Name:MINER, JEFFREY G (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:MINER
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 1:11 SHORE ROAD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890
Mailing Address - Country:US
Mailing Address - Phone:781-729-1810
Mailing Address - Fax:978-683-0663
Practice Address - Street 1:11 SHORE ROAD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890
Practice Address - Country:US
Practice Address - Phone:781-729-1810
Practice Address - Fax:978-683-0663
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303775Medicaid
H52592Medicare UPIN
MAA33395Medicare ID - Type Unspecified