Provider Demographics
NPI:1508064452
Name:MIRANDA, JUSTINE ARNESSA F (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE ARNESSA
Middle Name:F
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUSTINE ARNESSA
Other - Middle Name:FERIA
Other - Last Name:ZIPAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2110 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2313
Mailing Address - Country:US
Mailing Address - Phone:860-258-3470
Mailing Address - Fax:860-571-6800
Practice Address - Street 1:100 RETREAT AVE
Practice Address - Street 2:SUITE 903
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-246-2351
Practice Address - Fax:860-240-7063
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52304207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT52304OtherLICENSE