Healthcare Provider Details

I. General information

NPI: 1649319062
Provider Name (Legal Business Name): EDWARD P MIRIGLIANO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W PERIMETER RD
ANDREWS AIR FORCE BASE MD
20762-6601
US

IV. Provider business mailing address

10491 CARBERRY CT
WHITE PLAINS MD
20695-3288
US

V. Phone/Fax

Practice location:
  • Phone: 240-857-4530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC-004729-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: