Provider Demographics
NPI:1023195229
Name:MIRZA, FATIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NW ENGLEWOOD ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GLADSTONE
Mailing Address - State:MD
Mailing Address - Zip Code:64118
Mailing Address - Country:US
Mailing Address - Phone:816-455-1951
Mailing Address - Fax:816-455-0540
Practice Address - Street 1:101 NW ENGLEWOOD ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:GLADSTONE
Practice Address - State:MD
Practice Address - Zip Code:64118
Practice Address - Country:US
Practice Address - Phone:816-455-1951
Practice Address - Fax:816-455-0540
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD3RD37208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics