Provider Demographics
NPI:1043953979
Name:DJIOGAN, MATHILDE MIRANDA (DO)
Entity type:Individual
Prefix:DR
First Name:MATHILDE
Middle Name:MIRANDA
Last Name:DJIOGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 W BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-5596
Mailing Address - Country:US
Mailing Address - Phone:724-430-6598
Mailing Address - Fax:724-430-3932
Practice Address - Street 1:500 W BERKELEY ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-5596
Practice Address - Country:US
Practice Address - Phone:724-430-6598
Practice Address - Fax:724-430-3932
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS024874207R00000X
VA0116036262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine