MEDICARE: MAIWAND MIRWAIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0001X	Clinical Cardiac Electrophysiology Physician	MD490005	PA

General Provider Information

NPI Number	:	1386026235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIWAND MIRWAIS M.D.

Provider Business Mailing Address
First Line	:	1 CONVENTION AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4311
Country	:	US
Telephone Number	:	215-662-3999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CONVENTION AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4311
Country	:	US
Telephone Number	:	215-662-3999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	08/04/2025

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