Provider Demographics
NPI:1639174238
Name:MIRAGLIA, VINCENT P (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:P
Last Name:MIRAGLIA
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 1:2398 E OCEAN BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3310
Mailing Address - Country:US
Mailing Address - Phone:772-223-2864
Mailing Address - Fax:772-223-2861
Practice Address - Street 1:2398 E OCEAN BLVD
Practice Address - Street 2:STE A
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3310
Practice Address - Country:US
Practice Address - Phone:772-223-2864
Practice Address - Fax:772-223-2861
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-06-21
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
FLME16260208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1394149OtherFIRST HEALTH
FL406341246OtherRAILROAD MEDICARE
FL276653100Medicaid
FL4062425OtherAETNA
FL1166809004OtherCIGNA
FL43053OtherBLUE CROSS/BLUE SHIELD
FL43053OtherBLUE CROSS/BLUE SHIELD
FL4062425OtherAETNA
FLD54840Medicare UPIN