Provider Demographics
NPI:1922157973
Name:TIRGAN, M. HOSSEIN (MD)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:HOSSEIN
Last Name:TIRGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W 82ND ST
Mailing Address - Street 2:SUITE # 5 F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5406
Mailing Address - Country:US
Mailing Address - Phone:212-874-4200
Mailing Address - Fax:212-799-2594
Practice Address - Street 1:23 W 73RD ST
Practice Address - Street 2:SUITE # GD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3104
Practice Address - Country:US
Practice Address - Phone:212-874-4200
Practice Address - Fax:212-799-2594
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227957207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY024 082 44Medicaid
109985Medicare ID - Type Unspecified
A66297Medicare UPIN