Provider Demographics
NPI:1255320966
Name:MIEGEL, ROBERT ERNST (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERNST
Last Name:MIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20 GUEST ST STE 225
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2065
Mailing Address - Country:US
Mailing Address - Phone:617-738-8642
Mailing Address - Fax:617-202-4172
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:STE 505
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-491-6766
Practice Address - Fax:617-491-2552
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2019-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA47653207XS0114X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0161454Medicaid
A66493Medicare UPIN
MA1255320966Medicare NSC