Provider Demographics
NPI:1518905439
Name:MIR NEUROLOGY CENTER PA
Entity Type:Organization
Organization Name:MIR NEUROLOGY CENTER PA
Other - Org Name:SARIM R. MIR, M.D., P.A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT, SENIOR NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARIM
Authorized Official - Middle Name:RAHMAN
Authorized Official - Last Name:MIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-797-7600
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDC5469OtherMEDICARE RR PIN
MDDC5469OtherMEDICARE RR PIN