Healthcare Provider Details

I. General information

NPI: 1316967060
Provider Name (Legal Business Name): MIGUEL R AGUILO-SEARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 EGYPT RD
JEFFERSONVILLE PA
19403-3029
US

IV. Provider business mailing address

104 EGYPT RD
JEFFERSONVILLE PA
19403-3029
US

V. Phone/Fax

Practice location:
  • Phone: 610-277-5022
  • Fax: 610-277-5023
Mailing address:
  • Phone: 610-277-5022
  • Fax: 610-277-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD045318L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: