Mark Anthony Patatag Miranda Jr.

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

65 Wedgewood PL
Bridgeport, CT 06606-1927

Phone

(323) 365-4549

NPI assigned

Mar 12, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1720846959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 WEDGEWOOD PL",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 WEDGEWOOD PL",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061927",
            "telephone_number": "323-365-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "MARK ANTHONY",
        "middle_name": "PATATAG",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Marianne Minerowicz, M.D.
• Aygul Minibaeva, MD
• Tamara Mintz
• Miracle Care Services
• Miraclehands LLC
• Wendy Priya Miranda, M.D
• Mehwish Mirza, MD
• Amit Mishra, MD
• Kristen Misiak, LMSW
• Kimberly Susan Misiaszek, PHYSICAL THERAPIST

• Athletic Trainer in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Athletic Trainer in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.