Healthcare Provider Details

I. General information

NPI: 1619740552
Provider Name (Legal Business Name): TELEMERGE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 5TH ST STE 200
MIAMI BEACH FL
33139-6510
US

IV. Provider business mailing address

1000 5TH ST STE 200
MIAMI BEACH FL
33139-6510
US

V. Phone/Fax

Practice location:
  • Phone: 305-305-0310
  • Fax: 347-579-0008
Mailing address:
  • Phone: 305-305-0310
  • Fax: 347-579-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALTAGRACIA MIRANDA
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 305-305-0310