Provider Demographics
NPI:1295351922
Name:MIRZA, SAMIA FAROOK (DO)
Entity type:Individual
Prefix:DR
First Name:SAMIA
Middle Name:FAROOK
Last Name:MIRZA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CENTRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468
Mailing Address - Country:US
Mailing Address - Phone:905-598-2975
Mailing Address - Fax:
Practice Address - Street 1:28 CENTRE DRIVE
Practice Address - Street 2:UVMMC- FAMILY MEDICINE MILTON
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468
Practice Address - Country:US
Practice Address - Phone:802-847-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program