Provider Demographics
NPI:1366450777
Name:MM IRANI MD PC
Entity Type:Organization
Organization Name:MM IRANI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MAHAKHURSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:IRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-250-0437
Mailing Address - Street 1:2030 LEHIGH ST
Mailing Address - Street 2:# 116
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042
Mailing Address - Country:US
Mailing Address - Phone:610-250-0437
Mailing Address - Fax:610-250-5812
Practice Address - Street 1:2030 LEHIGH ST
Practice Address - Street 2:# 116
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-250-0437
Practice Address - Fax:610-250-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038871L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011959800001Medicaid
PA0011959800001Medicaid
C31199Medicare UPIN