Healthcare Provider Details

I. General information

NPI: 1457383549
Provider Name (Legal Business Name): CHONA SANTOS-MIRANDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 PHILADELPHIA AVE
EGG HARBOR CITY NJ
08215
US

IV. Provider business mailing address

630 BELLEVUE AVE
HAMMONTON NJ
08037
US

V. Phone/Fax

Practice location:
  • Phone: 609-965-5700
  • Fax: 609-965-5719
Mailing address:
  • Phone: 609-561-7548
  • Fax: 609-561-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06592600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: