Jacob, Glen Mirandilla

Jacob, Glen Mirandilla is an individual health care provider with primary practice located at 1221 Mercantile Lane , Largo MD 20774-5374. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Jacob, Glen Mirandilla can be contacted via phone (301) 618-5578.

Contact Information

Primary practice address
1221 Mercantile Lane Largo MD 20774-5374
Phone: (301) 618-5578
Fax: (301) 618-5673
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD034269 District of Columbia
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 9880 New Mexico
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X D59633 Maryland
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X D59633 Maryland

Profile Details

NPI number 1780757062
LBN Legal business name Jacob, Glen Mirandilla
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 16th, 2006
Last updated Feb 23rd, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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