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General NPI Number Information
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NPI Number | 1437147139
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Entity Type | Individual
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Provider Name | MARINA ALEKSANDROVNA MIRONOVA MD
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Gender | Female
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 302 UNIVERSITY PARKWAY
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City | AIKEN
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State | SC
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Zip | 29801
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Country | US
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Telephone | 803-641-5300
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Fax | 803-641-5767
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Provider Business Mailing Address
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Address Line | 302 UNIVERSITY PARKWAY
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City | AIKEN
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State | SC
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Zip | 29801
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Country | US
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Telephone | 803-641-5300
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Fax | 803-641-5767
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 26162
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License Number State | SC
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