Provider Demographics
NPI:1700983046
Name:MIRANDA, ROGELIO SARMINTO (MD)
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:SARMINTO
Last Name:MIRANDA
Suffix:
Gender:M
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:PO BOX 712893
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-2893
Mailing Address - Country:US
Mailing Address - Phone:800-517-0856
Mailing Address - Fax:800-517-0856
Practice Address - Street 1:850 E XENIA DR
Practice Address - Street 2:STE. 200
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-8747
Practice Address - Country:US
Practice Address - Phone:937-352-2870
Practice Address - Fax:937-352-2874
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035005207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0392856Medicaid
OH000000500363OtherANTHEM
B95497Medicare UPIN
OH000000500363OtherANTHEM