Active NPI
David John Miranda, PHD
- Clinical Psychologist
- Baltimore, MD
National Provider Identifier
1255044483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 02969
- Practice address
- 202 Homewood Ter
Baltimore, MD 21218-2804 - Phone
- (410) 255-1680
- NPI assigned
- Jan 3, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 02969 | MD | Primary |
Addresses
Primary practice location
202 Homewood Ter
Baltimore, MD 21218-2804
Mailing address
202 Homewood Ter
Baltimore, MD 21218-2804
Phone (410) 255-1680
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2023 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672704000000",
"number": "1255044483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 HOMEWOOD TER",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212182804",
"telephone_number": "410-255-1680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 HOMEWOOD TER",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212182804",
"telephone_number": "410-255-1680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRANDA",
"first_name": "DAVID",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-03",
"last_updated": "2023-01-03",
"certification_date": "2023-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "02969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.