Provider Demographics
NPI:1508830829
Name:DR. TAMADER H. MIRA, P.A.
Entity Type:Organization
Organization Name:DR. TAMADER H. MIRA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMADER
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-440-4827
Mailing Address - Street 1:5505 RITCHIE HWY
Mailing Address - Street 2:E
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3444
Mailing Address - Country:US
Mailing Address - Phone:410-355-0340
Mailing Address - Fax:410-636-3403
Practice Address - Street 1:5505 RITCHIE HWY
Practice Address - Street 2:E
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-3444
Practice Address - Country:US
Practice Address - Phone:410-355-0340
Practice Address - Fax:410-636-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD912081500Medicaid
MD912081500Medicaid
MDH655Medicare PIN
MD=========OtherTAX ID NUMBER