Healthcare Provider Details

I. General information

NPI: 1073567764
Provider Name (Legal Business Name): RONNIE JOHN MIGNELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 COAL VALLEY ROAD SUITE 570
JEFFERSON HILLS PA
15025-3729
US

IV. Provider business mailing address

575 COAL VALLEY ROAD SUITE 570
JEFFERSON HILLS PA
15025-3729
US

V. Phone/Fax

Practice location:
  • Phone: 412-469-7660
  • Fax: 412-469-7547
Mailing address:
  • Phone: 412-469-7660
  • Fax: 412-469-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD047319L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD047319L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number17742
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD2023-1388
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD047319L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2024-00880
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: