1801934393 NPI number — DR. CHARLES C MIRAGLIA M.D.

Table of content: DR. CHARLES C MIRAGLIA M.D. (NPI 1801934393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801934393 NPI number — DR. CHARLES C MIRAGLIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRAGLIA
Provider First Name:
CHARLES
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801934393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 W WHITE RIVER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47303-4988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-254-6200
Provider Business Mailing Address Fax Number:
765-741-5601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 W UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47303-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-284-7795
Provider Business Practice Location Address Fax Number:
765-741-2905
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZB0001X , with the licence number:  01044095 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207ZP0102X , with the licence number: 01044095 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1686 . This is a "PHYSICIAN HEALTH PLAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2099563 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000026718 . This is a "M-PLAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000255389 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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