Provider Demographics
NPI:1508138314
Name:PIRMOHAMED, FERMINA ALIA (MD)
Entity Type:Individual
Prefix:
First Name:FERMINA
Middle Name:ALIA
Last Name:PIRMOHAMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5880 49TH ST N
Mailing Address - Street 2:STE 104
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2150
Mailing Address - Country:US
Mailing Address - Phone:727-528-6100
Mailing Address - Fax:727-528-7895
Practice Address - Street 1:11215 METRO PKWY STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1206
Practice Address - Country:US
Practice Address - Phone:239-208-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4721542084N0400X
NH210432084N0400X
MT988752084N0400X
MO20210065642084N0400X
TXS67112084N0400X
FLME1305472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019534200Medicaid
FLIV096ZOtherMEDICARE PTAN