Healthcare Provider Details

I. General information

NPI: 1952530511
Provider Name (Legal Business Name): RAUL ALEXANDER MIRZA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2009
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 EAGLE WAY
DOVER DE
19902-5058
US

IV. Provider business mailing address

14216 WESTSIDE RIDGE DR
LAUREL MD
20707-6257
US

V. Phone/Fax

Practice location:
  • Phone: 305-799-5378
  • Fax:
Mailing address:
  • Phone: 305-799-5378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberH0093627
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberH0093627
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: