Provider Demographics
NPI:1841213279
Name:A.C.MIRANDA M.D.PA
Entity Type:Organization
Organization Name:A.C.MIRANDA M.D.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:APOLINARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:609-561-7548
Mailing Address - Street 1:630 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1935
Mailing Address - Country:US
Mailing Address - Phone:609-561-7548
Mailing Address - Fax:609-561-7520
Practice Address - Street 1:630 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1935
Practice Address - Country:US
Practice Address - Phone:609-561-7548
Practice Address - Fax:609-561-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12224000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD18524Medicare UPIN