Provider Demographics
NPI:1326302399
Name:MIRANDA, NATALIA (MD)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 WOODBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1856
Mailing Address - Country:US
Mailing Address - Phone:215-750-6611
Mailing Address - Fax:
Practice Address - Street 1:163 ROUTE 130
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2248
Practice Address - Country:US
Practice Address - Phone:609-537-7200
Practice Address - Fax:609-896-3986
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09951500207V00000X, 207VG0400X, 207VX0000X
PAMD457512207V00000X
PAMT201323207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics