Provider Demographics
NPI:1952530511
Name:MIRZA, RAUL ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ALEXANDER
Last Name:MIRZA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14216 WESTSIDE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6257
Mailing Address - Country:US
Mailing Address - Phone:305-799-5378
Mailing Address - Fax:
Practice Address - Street 1:215 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19902-5058
Practice Address - Country:US
Practice Address - Phone:305-799-5378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00936272083X0100X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine