Provider Demographics
NPI:1316196124
Name:MIRZAA, GHAYDA (MD)
Entity Type:Individual
Prefix:MS
First Name:GHAYDA
Middle Name:
Last Name:MIRZAA
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 1:1900 9TH AVE
Mailing Address - Street 2:MAILSTOP C9S-10
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1309
Mailing Address - Country:US
Mailing Address - Phone:773-895-0555
Mailing Address - Fax:
Practice Address - Street 1:1900 9TH AVE
Practice Address - Street 2:MAILSTOP C9S-10
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1309
Practice Address - Country:US
Practice Address - Phone:773-895-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121470390200000X
WA60286450207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program