Provider Demographics
NPI:1376517771
Name:BAR-ON, MIRIAM (MD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:BAR-ON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:3006 S MARYLAND PKWY STE 315
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-6205
Practice Address - Country:US
Practice Address - Phone:702-992-6868
Practice Address - Fax:702-992-6860
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV12118208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12118OtherMEDICAL LICENSE
IL35.051373OtherMEDICAL LICENSE
D51881Medicare UPIN