Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036-119777 | IL |
N | 208600000X | Surgeon | 036-119777 | IL |
N | 2086S0102X | Surgical Critical Care | 042481 | CT |
Y | 2086S0102X | Surgical Critical Care | 257617 | MA |
N | 2086S0102X | Surgical Critical Care | 4301072064 | MI |
NPI | 1063690691 |
---|---|
Provider Name | Tahira F Mirza |
First Address | South Weymouth, MA 02190-2432 |
Second Address | Weymouth, MA 02190-2432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2008 |
Last Update Date | 24/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036119777 | (05) | IL |