Basic Information
| Provider Information | |||||||||
| NPI: | 1346278165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIRANDA | ||||||||
| FirstName: | FERNANDO | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 440100 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372440100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153290570 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3443 DICKERSON PIKE | ||||||||
| Address2: | STE 760 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372072519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158601556 | ||||||||
| FaxNumber: | 6158601558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 01/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 11379 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3174409 | 05 | TN | MEDICAID | 4082067 | 01 | AETNA | OTHER | 64923212 | 05 | KY | MEDICAID | 3640063 | 01 | UNITED HEALTHCARE | OTHER | 830002155 | 01 | RAILROAD MEDICARE | OTHER | 0015731 | 01 | BCBS OF TN | OTHER |