Kenneth R Mink, MD

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

MD054676L Issued in PA

Practice address

3800 W 12TH St
Erie, PA 16505-3380

Phone

(814) 833-0399

Fax

(814) 833-4999

NPI assigned

May 24, 2005

Sex

Male

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196208000000",
    "number": "1932102829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 W 12TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165053380",
            "telephone_number": "814-833-0399",
            "fax_number": "814-833-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 W 12TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165053380",
            "telephone_number": "814-833-0399",
            "fax_number": "814-833-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINK",
        "first_name": "KENNETH",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2007-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "PA",
            "license": "MD054676L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Procedural Dermatology Physician in Erie, PA
• Providers in Erie, PA by specialty
• Procedural Dermatology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; 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.