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Individual

DR. CHARLES DAVID MIRON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
3200 TIMBERFIELD LN, BALTIMORE, MD 21208-4422
(410) 653-3777
Mailing address
3200 TIMBERFIELD LN, BALTIMORE, MD 21208-4422
(410) 653-3777

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
738
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
34253001
BLUE CROSS NUMBER
MD
01
G599
BLUE CROSSBLUE SHIELD
MD
01
R778
BLUE CHOICE NUMBER
MD
Enumeration date
11/20/2006
Last updated
07/08/2007
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