Provider Demographics
NPI:1174585855
Name:MINA, RANDA (MD)
Entity type:Individual
Prefix:MRS
First Name:RANDA
Middle Name:
Last Name:MINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RANDA
Other - Middle Name:FAHIM
Other - Last Name:MINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2087 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3416
Mailing Address - Country:US
Mailing Address - Phone:609-587-1001
Mailing Address - Fax:609-587-0227
Practice Address - Street 1:2087 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-587-2300
Practice Address - Fax:609-587-8660
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07656800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029726Medicaid
074669Medicare ID - Type Unspecified
NJ0029726Medicaid