Provider Demographics
NPI:1588684757
Name:MIR, YASIR M (DPM)
Entity Type:Individual
Prefix:DR
First Name:YASIR
Middle Name:M
Last Name:MIR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 SOUTH WASHINGTON STREET
Mailing Address - Street 2:SUITE 12
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325
Mailing Address - Country:US
Mailing Address - Phone:717-334-1800
Mailing Address - Fax:717-334-0853
Practice Address - Street 1:295 STONER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5698
Practice Address - Country:US
Practice Address - Phone:410-848-6800
Practice Address - Fax:410-857-4227
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD01411213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA118671OtherMEDICARE GROUP PIN
MD7601926OtherAETNA
PA1018772680002Medicaid
MD89727903OtherBCBS
PA1958354OtherBCBS
MD89727903OtherBCBS
MD7601926OtherAETNA
MDV07650Medicare UPIN