Provider Demographics
NPI:1336255884
Name:TUDOSIE, MIOARA (MD)
Entity type:Individual
Prefix:
First Name:MIOARA
Middle Name:
Last Name:TUDOSIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4347 PORTAGE ST NW STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7371
Mailing Address - Country:US
Mailing Address - Phone:800-527-0336
Mailing Address - Fax:330-244-8521
Practice Address - Street 1:2600 WEST TUSCARAWAS ST
Practice Address - Street 2:SUITE 640
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-455-1511
Practice Address - Fax:330-455-5028
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0914210Medicaid
F42152Medicare UPIN
OH0914210Medicaid