Provider Demographics
NPI:1386622942
Name:MIRANDO, WILLIAM S (M D)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:MIRANDO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 N RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4134
Mailing Address - Country:US
Mailing Address - Phone:440-998-3376
Mailing Address - Fax:440-997-5751
Practice Address - Street 1:2885 N RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4134
Practice Address - Country:US
Practice Address - Phone:440-998-3376
Practice Address - Fax:440-997-5751
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-0349M207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0892780Medicaid
OH9349603Medicare PIN
OHF37607Medicare UPIN
OH9349602Medicare PIN
OH0892780Medicaid