Individual
DR. CHARLES DAVID MIRON
Active
Individual
DR. CHARLES DAVID MIRON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
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
Update your record
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