Provider Demographics
NPI:1689776825
Name:RALPH A MIRANDA MD
Entity Type:Organization
Organization Name:RALPH A MIRANDA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-838-7632
Mailing Address - Street 1:196 OLD ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-838-7632
Mailing Address - Fax:724-836-3655
Practice Address - Street 1:196 OLD ROUTE 30
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-838-7632
Practice Address - Fax:724-836-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019744E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA49858OtherBLUE SHIELD
359676OtherHEALTH ASSURANCE
1420493OtherUMWA
326488OtherUPMC
359676OtherHEALTH ASSURANCE
49858Medicare ID - Type UnspecifiedMEDICARE