Provider Demographics
NPI:1336221464
Name:MIRZA, FARAH NEELAM
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:NEELAM
Last Name:MIRZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E 21ST ST STE 400
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1269
Mailing Address - Country:US
Mailing Address - Phone:484-526-7275
Mailing Address - Fax:833-820-1011
Practice Address - Street 1:602 E 21ST ST STE 400
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1269
Practice Address - Country:US
Practice Address - Phone:484-526-7275
Practice Address - Fax:833-820-1011
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS013857OtherSTATE LICENCE