Provider Demographics
NPI:1437123783
Name:MIRANDE, MELANIE ETHELL (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ETHELL
Last Name:MIRANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6525 MARKET AVE N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2430
Mailing Address - Country:US
Mailing Address - Phone:330-494-9785
Mailing Address - Fax:330-494-9798
Practice Address - Street 1:6525 MARKET AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-2430
Practice Address - Country:US
Practice Address - Phone:330-494-9785
Practice Address - Fax:330-494-9798
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35072373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871218Medicaid