Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 036112206 | IL |
N | 207RC0200X | Critical Care Medicine | 12939 | NH |
N | 207RP1001X | Pulmonary Disease | 036112206 | IL |
Y | 207RP1001X | Pulmonary Disease | 12939 | NH |
NPI | 1063552008 |
---|---|
Provider Name | Dr. Julio A. Miranda |
First Address | Northampton, MA 01060-2052 |
Second Address | Northampton, MA 01060-2052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 30/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S400239406 | (02) | MA |