Provider Demographics
NPI:1497841183
Name:MOHABIR, MIRANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:
Last Name:MOHABIR
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 1:8295 CAZENOVIA RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-8744
Mailing Address - Country:US
Mailing Address - Phone:315-682-0213
Mailing Address - Fax:315-682-4411
Practice Address - Street 1:8295 CAZENOVIA RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-8744
Practice Address - Country:US
Practice Address - Phone:315-682-0213
Practice Address - Fax:315-682-4411
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2301292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0879Medicare ID - Type Unspecified