Provider Demographics
NPI:1770526766
Name:MERIDA, MIGDALIA (MD)
Entity type:Individual
Prefix:
First Name:MIGDALIA
Middle Name:
Last Name:MERIDA
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 1:36739 STATE ROAD 52 101
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5101
Mailing Address - Country:US
Mailing Address - Phone:352-437-5970
Mailing Address - Fax:352-437-5998
Practice Address - Street 1:36739 STATE ROAD 52 101
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5101
Practice Address - Country:US
Practice Address - Phone:352-437-5970
Practice Address - Fax:352-437-5998
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74618207P00000X, 207R00000X
WAMD60417663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258485900Medicaid
FL221247OtherAMERIGROUP
FL46284OtherBLUE CROSS OF FLORIDA
FL46284XMedicare PIN
FLG87954Medicare UPIN
110216559Medicare PIN