Healthcare Provider Details

I. General information

NPI: 1326302399
Provider Name (Legal Business Name): NATALIA MIRANDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 ROUTE 130
BORDENTOWN NJ
08505-2248
US

IV. Provider business mailing address

540 WOODBOURNE RD
LANGHORNE PA
19047-1856
US

V. Phone/Fax

Practice location:
  • Phone: 609-537-7200
  • Fax: 609-896-3986
Mailing address:
  • Phone: 215-750-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09951500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD457512
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA09951500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number25MA09951500
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT201323
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: