Healthcare Provider Details

I. General information

NPI: 1902041437
Provider Name (Legal Business Name): MIRA MAHAJAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRINALINI SIROHI MD

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CLEARWATER LARGO RD N SUITE 2
LARGO FL
33770-2388
US

IV. Provider business mailing address

150 CLEARWATER LARGO RD N SUITE 2
LARGO FL
33770-2388
US

V. Phone/Fax

Practice location:
  • Phone: 727-518-0822
  • Fax: 707-518-6511
Mailing address:
  • Phone: 727-518-0822
  • Fax: 707-518-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME104997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: