Provider Demographics
NPI:1629868062
Name:BAQAI, MIFRAH
Entity type:Individual
Prefix:
First Name:MIFRAH
Middle Name:
Last Name:BAQAI
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 1:10140 SADDLEBROOK FARM TRAIL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163
Mailing Address - Country:US
Mailing Address - Phone:215-435-7195
Mailing Address - Fax:
Practice Address - Street 1:15 W 136TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2104
Practice Address - Country:US
Practice Address - Phone:215-435-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program