| Imelda Miranda, M.d. | |
|
7611 S Osborne Rd Upper Marlboro MD 20772-4200 | |
| (301) 952-8401 | |
| (301) 952-8464 |
| Full Name | Imelda Miranda, M.d. |
|---|---|
| Speciality | Internal Medicine |
| Location | 7611 S Osborne Rd, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Imelda R Miranda (M.D.) |
| Authorized Official Contact | 3019528401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imelda Miranda, M.d. Po Box 2238 Upper Marlboro MD 20773-2238 Ph: (301) 952-8401 | Imelda Miranda, M.d. 7611 S Osborne Rd Upper Marlboro MD 20772-4200 Ph: (301) 952-8401 |
| NPI Number | 1003090812 |
|---|---|
| Provider Enumeration Date | 12/28/2007 |
| Last Update Date | 12/28/2007 |
| Medicare PECOS PAC ID | 3274544960 |
|---|---|
| Medicare Enrollment ID | O20060509000691 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003090812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D0043276 (Maryland) | Primary |
| Provider Name | Imelda R Miranda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578510681 PECOS PAC ID: 4082625777 Enrollment ID: I20111229000180 |
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