Provider Demographics
NPI:1700824125
Name:MIRAN, MOHAMMAD (DO)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:MIRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 TWIN PEAKS CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5916
Mailing Address - Country:US
Mailing Address - Phone:516-810-4496
Mailing Address - Fax:
Practice Address - Street 1:1110 OPAL CT STE 4&5
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5942
Practice Address - Country:US
Practice Address - Phone:301-745-6392
Practice Address - Fax:301-745-6359
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0083539207RS0012X
WI55546207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100213B3LMedicare ID - Type Unspecified