Provider Demographics
NPI:1639124365
Name:MIRARCHI, SAVERIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SAVERIO
Middle Name:
Last Name:MIRARCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-2882
Mailing Address - Fax:410-328-7607
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-2882
Practice Address - Fax:410-328-7607
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46197207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1639124365Medicaid
MD307871000OtherBLUE CROSS/BLUE SHIELD
MD307871000Medicaid
MD307871000Medicaid
MDF90291Medicare UPIN
MD110236507Medicare PIN