Provider Demographics
NPI:1982027983
Name:AXELROD, MIRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:AXELROD
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:PO BOX 26370
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-6370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:371 BRICKMAN RD
Practice Address - Street 2:
Practice Address - City:HURLEYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12747-6001
Practice Address - Country:US
Practice Address - Phone:845-434-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD13497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine