Provider Demographics
NPI:1548384365
Name:SURJADI, MIRANDA E (NP MS)
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:E
Last Name:SURJADI
Suffix:
Gender:F
Credentials:NP MS
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Mailing Address - Street 1:1001 POTRERO AVE # 3D7
Mailing Address - Street 2:SFGH GASTROENTEROLOGY
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-4776
Mailing Address - Fax:415-206-5199
Practice Address - Street 1:1001 POTRERO AVE # 3D7
Practice Address - Street 2:SFGH GASTROENTEROLOGY
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-4776
Practice Address - Fax:415-206-5199
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN546712163WG0100X
CANPF11790363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
Not Answered363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
117390OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
P19200Medicare UPIN