Provider Demographics
NPI:1982325304
Name:AFSHARPAD, MITRA (MD)
Entity Type:Individual
Prefix:
First Name:MITRA
Middle Name:
Last Name:AFSHARPAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MITRA
Other - Middle Name:
Other - Last Name:AFSHARPAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4907 W PINE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1400
Mailing Address - Country:US
Mailing Address - Phone:314-642-2774
Mailing Address - Fax:
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-588-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022018398207ZP0101X
KY58540207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty