Provider Demographics
NPI:1154470946
Name:MIR, TASEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:TASEEN
Middle Name:
Last Name:MIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1801 ROBERT FULTON DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5461
Mailing Address - Country:US
Mailing Address - Phone:703-876-9300
Mailing Address - Fax:703-876-9811
Practice Address - Street 1:1801 ROBERT FULTON DR
Practice Address - Street 2:SUITE 140
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5461
Practice Address - Country:US
Practice Address - Phone:703-876-9300
Practice Address - Fax:703-876-9811
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101242624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0803811012OtherBCBS
MII46212Medicare UPIN
MII46212Medicare UPIN