Provider Demographics
NPI:1710107180
Name:GARCELLANO, MIRIAM L (DO)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:L
Last Name:GARCELLANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:LORRAINE
Other - Last Name:GARCELLANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3525 OLENTANGY RIVER RD STE 4330
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3937
Mailing Address - Country:US
Mailing Address - Phone:614-255-6900
Mailing Address - Fax:614-255-6901
Practice Address - Street 1:3525 OLENTANGY RIVER RD STE 4330
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-255-6900
Practice Address - Fax:614-255-6901
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1170207Q00000X
MI5101016318207QH0002X
OH34.010542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00906562OtherRAILROAD MEDICARE PTAN
OH0072014Medicaid
SC011702Medicaid
SC011702Medicaid
OHH125301Medicare PIN
SCAA55791850Medicare PIN
OHH125300Medicare PIN