Marissa Lynne Mincolla, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

270174 Issued in NY

Practice address

750 E Adams St
Syracuse, NY 13210-2342

Phone

(315) 464-7434

NPI assigned

Apr 27, 2009

Last updated

May 20, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369008000000",
    "number": "1619111234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7510 MEADOW WOOD DR",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132121042",
            "telephone_number": "315-559-7137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102342",
            "telephone_number": "315-464-7434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINCOLLA",
        "first_name": "MARISSA",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-27",
        "last_updated": "2013-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "270174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivy Nichelle Mills, LPN
• James H Mills, MD
• Lynn M Millson
• Sarah Faith Millward, LMSW
• Brian S Min, MD
• Mind, Body & Spirit Marriage and Family Therapy
• Amna Minhas, MBBS
• Mark Richard Minnick, PH.D.
• Julia Irene Minoia, N.P.
• Gwendalyn R Minton, MSW

• Diagnostic Radiology Physician in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.