Provider Demographics
NPI:1760707327
Name:KAGA, MIRA KAMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRA
Middle Name:KAMAL
Last Name:KAGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1451
Mailing Address - Country:US
Mailing Address - Phone:732-719-2001
Mailing Address - Fax:732-719-2002
Practice Address - Street 1:58 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1451
Practice Address - Country:US
Practice Address - Phone:732-719-2001
Practice Address - Fax:732-719-2002
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09379200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ322546RNSOtherPTAN