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NPI Code Detail

MEDICARE: ANTHONY MIRANDA

MEDICARE: ANTHONY MIRANDA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA102473MA

General Provider Information

NPI Number : 1306662960
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY MIRANDA
Provider Business Mailing Address
First Line : 41 RESNIK RD
Second Line :
City : PLYMOUTH
State : MA
Zip : 02360-5721
Country : US
Telephone Number :
Fax Number : 508-746-3930
Provider Business Practice Location Address
First Line : 41 RESNIK RD
Second Line :
City : PLYMOUTH
State : MA
Zip : 02360-5721
Country : US
Telephone Number : 781-934-2400
Fax Number : 508-746-3930
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2024
Last Update Date : 04/13/2026

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Directions to “ ANTHONY MIRANDA ” Practice Location

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