Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1170 | SC |
Y | 207Q00000X | Family Doctor | 34010542 | OH |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 5101016318 | MI |
NPI | 1710107180 |
---|---|
Provider Name | Miriam L Garcellano |
First Address | Westerville, OH 43082-9808 |
Second Address | Westerville, OH 43082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 06/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0072014 | (05) | OH |
011702 | (05) | SC |
FG0197916 | DEA (01) | SC |
P00906562 | RAILROAD MEDICARE PTAN (01) | SC |