Individual
MARINA ALEKSANDROVNA MIRONOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
302 UNIVERSITY PARKWAY, AIKEN, SC 29801
(803) 641-5300
(803) 641-5767
Mailing address
302 UNIVERSITY PARKWAY, AIKEN, SC 29801
(803) 641-5300
(803) 641-5767
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
26162
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00739354
RAIL ROAD MEDICARE
SC
01
—
P00851424
RR MEDICARE PTAN
SC
Enumeration date
10/07/2005
Last updated
10/18/2010
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