Provider Demographics
NPI:1497793087
Name:MIR, SARIM RAHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SARIM
Middle Name:RAHMAN
Last Name:MIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD
Mailing Address - Street 2:SUITE 151
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6700
Mailing Address - Country:US
Mailing Address - Phone:301-797-7600
Mailing Address - Fax:301-797-1249
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUITE 151
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6700
Practice Address - Country:US
Practice Address - Phone:301-797-7600
Practice Address - Fax:301-797-1249
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00508072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0090506000OtherWVMA
MD130018253OtherMBRR
MDOM34OtherBCPC
MD0500381OtherUNITED HEALTH CARE
MD177103500OtherMAMD
MD545515OtherAET
MD886M655FOtherMBMD
MDOM34OtherBCBS
MD130018253OtherMEDICARE RR-INDIVIDUAL
1524420OtherUMW
MD441331OtherMAMSI
MD522091771003OtherCIGNA
MD177103500Medicaid
MDM1908976OtherBSPA
MD130018253OtherCHES
MDDC5469OtherMEDICARE RR
MD886MMedicare PIN
MD130018253OtherCHES
MD0500381OtherUNITED HEALTH CARE