Provider Demographics
NPI:1457383549
Name:SANTOS-MIRANDA, CHONA (MD)
Entity type:Individual
Prefix:DR
First Name:CHONA
Middle Name:
Last Name:SANTOS-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 1:630 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037
Mailing Address - Country:US
Mailing Address - Phone:609-561-7548
Mailing Address - Fax:609-561-7526
Practice Address - Street 1:204 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215
Practice Address - Country:US
Practice Address - Phone:609-965-5700
Practice Address - Fax:609-965-5719
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06592600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG87104Medicare UPIN