Provider Demographics
NPI:1447273354
Name:MIRANDA, RALPH A (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:A
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 OLD ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-838-7632
Mailing Address - Fax:724-836-3655
Practice Address - Street 1:196 OLD ROUTE 30
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-838-7632
Practice Address - Fax:724-836-3655
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019744E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA49858OtherHIGHMARK BLUE SHIELD
326488OtherUPMC
1420493OtherUMWA
359676OtherHEALTH ASSURANCE
49858Medicare ID - Type Unspecified
C28425Medicare UPIN