Provider Demographics
NPI:1447415971
Name:MIR, SADAF N (MD)
Entity Type:Individual
Prefix:DR
First Name:SADAF
Middle Name:N
Last Name:MIR
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 1:206 CORNELIA ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2878
Mailing Address - Country:US
Mailing Address - Phone:518-562-7705
Mailing Address - Fax:
Practice Address - Street 1:206 CORNELIA ST
Practice Address - Street 2:SUITE 307
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2878
Practice Address - Country:US
Practice Address - Phone:518-562-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278853207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04167885Medicaid
NY04167885Medicaid