Provider Demographics
NPI:1245269919
Name:MIANO, MICHELE A (MD)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:A
Last Name:MIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:741 MARLTON PIKE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3527
Mailing Address - Country:US
Mailing Address - Phone:856-795-8787
Mailing Address - Fax:856-795-8688
Practice Address - Street 1:741 MARLTON PIKE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3527
Practice Address - Country:US
Practice Address - Phone:856-795-8787
Practice Address - Fax:856-795-8688
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57594207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F19252Medicare UPIN