Provider Demographics
NPI:1154320364
Name:MIRARCHI, FERDINANDO
Entity Type:Individual
Prefix:
First Name:FERDINANDO
Middle Name:
Last Name:MIRARCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 STATE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009857L207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025763101OtherUNIVERA
OH2284068OtherOH MEDICAL ASSISTANCE
PA189808OtherBLUE SHIELD
WV1068835OtherWEST VIRGINIA WORK COMP
PA2894671OtherAETNA
PA0017453550008Medicaid
PA930110078OtherRR MEDICARE
NY01984312OtherNY MEDICAL ASSISTANCE
PA300898OtherUPMC
PA125590OtherUNISON
PA1510452OtherGATEWAY
PA125590OtherUNISON
PA930110078OtherRR MEDICARE