Provider Demographics
NPI:1023205887
Name:MIRA, TAMADER H (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMADER
Middle Name:H
Last Name:MIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5505 RITCHIE HWY
Mailing Address - Street 2:E
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3444
Mailing Address - Country:US
Mailing Address - Phone:410-355-0340
Mailing Address - Fax:410-636-3403
Practice Address - Street 1:5505 RITCHIE HWY
Practice Address - Street 2:E
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-3444
Practice Address - Country:US
Practice Address - Phone:410-355-0340
Practice Address - Fax:410-636-3403
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2011-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0066019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413777900Medicaid
MD413777900Medicaid
MDR770Medicare PIN