Provider Demographics
NPI:1346336674
Name:MIRZABEIGI, MARJAN (MD)
Entity Type:Individual
Prefix:
First Name:MARJAN
Middle Name:
Last Name:MIRZABEIGI
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 1:3141 W MCNAB RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4806
Mailing Address - Country:US
Mailing Address - Phone:954-977-6977
Mailing Address - Fax:954-977-6922
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-5569
Practice Address - Fax:954-355-5568
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91584207ZP0101X, 207ZP0102X
MA244555207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110101125AMedicaid
MAM21750Medicare PIN
MA110101125AMedicaid