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General NPI Number Information
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NPI Number | 1992939979
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Entity Type | Individual
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Provider Name | MIRANDA CORDELL MD
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Gender | Female
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 10/25/2020
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Provider Practice Location Address
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Address Line | 16139 LANCASTER HWY STE 110
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City | CHARLOTTE
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State | NC
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Zip | 28277-2033
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Country | US
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Telephone | 704-384-1440
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 704-316-4445
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Fax | 704-316-4446
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 156757
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2012-00817
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License Number State | NC
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