Provider Demographics
NPI:1558389874
Name:MIRANDA, ZANE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ZANE
Middle Name:A
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 JANSEN RD
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:NY
Mailing Address - Zip Code:12531-5202
Mailing Address - Country:US
Mailing Address - Phone:845-878-2296
Mailing Address - Fax:
Practice Address - Street 1:138 JANSEN RD
Practice Address - Street 2:
Practice Address - City:HOLMES
Practice Address - State:NY
Practice Address - Zip Code:12531-5202
Practice Address - Country:US
Practice Address - Phone:845-878-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107307207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology