Provider Demographics
NPI:1417416520
Name:ARMSTRONG GILMORE, MIANNA MARIE
Entity Type:Individual
Prefix:
First Name:MIANNA
Middle Name:MARIE
Last Name:ARMSTRONG GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6482 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7312
Mailing Address - Country:US
Mailing Address - Phone:614-839-5555
Mailing Address - Fax:614-839-5100
Practice Address - Street 1:6482 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7312
Practice Address - Country:US
Practice Address - Phone:614-839-5555
Practice Address - Fax:614-839-5100
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016334207VX0000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics