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General NPI Number Information
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NPI Number | 1114374303
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Entity Type | Individual
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Provider Name | VARVARA S MIRONOVA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 71 HAYNES ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4131
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Country | US
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Telephone | 203-785-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 25233 TOWN WALK DR
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City | HAMDEN
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State | CT
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Zip | 06518-5336
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Country | US
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Telephone | 315-559-0226
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 1.076729
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License Number State | CT
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