Provider Demographics
NPI:1902041437
Name:MAHAJAN, MIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRA
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MRINALINI
Other - Middle Name:
Other - Last Name:SIROHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 CLEARWATER LARGO RD N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2388
Mailing Address - Country:US
Mailing Address - Phone:727-518-0822
Mailing Address - Fax:707-518-6511
Practice Address - Street 1:150 CLEARWATER LARGO RD N
Practice Address - Street 2:SUITE 2
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2388
Practice Address - Country:US
Practice Address - Phone:727-518-0822
Practice Address - Fax:707-518-6511
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine