Active NPI
Gianni B Migliaccio, PA-C
- Physician Assistant
- Havre de Grace, MD
National Provider Identifier
1376737411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- C05654
- Practice address
- 800 Tydings LN
Havre de Grace, MD 21078-2102 - Phone
- (410) 273-6600
- Fax
- (410) 734-2305
- NPI assigned
- Aug 31, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 012255 | NY | |
| Physician Assistant | 363A00000X | C05654 | MD | Primary |
| Physician Assistant | 363A00000X | 0110003850 | VA |
Addresses
Primary practice location
800 Tydings LN
Havre de Grace, MD 21078-2102
Mailing address
800 Tydings LN
Havre de Grace, MD 21078-2102
Phone (410) 273-6600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02951164 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C05654 | MD | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Commonwealth Orthopaedics & Rehabilitation, PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthopaedic Surgery Physician
- Fairfax, VA
- NPI 1295829893
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697414400000",
"number": "1376737411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 TYDINGS LN",
"city": "HAVRE DE GRACE",
"state": "MD",
"postal_code": "210782102",
"telephone_number": "410-273-6600",
"fax_number": "410-734-2305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 TYDINGS LN",
"city": "HAVRE DE GRACE",
"state": "MD",
"postal_code": "210782102",
"telephone_number": "410-273-6600",
"fax_number": "410-734-2305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIGLIACCIO",
"first_name": "GIANNI",
"middle_name": "B",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-31",
"last_updated": "2023-10-16",
"certification_date": "2023-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "012255",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MD",
"license": "C05654",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110003850",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02951164",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Havre de Grace, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.