Healthcare Provider Details

I. General information

NPI: 1407791148
Provider Name (Legal Business Name): MIRGHANI F MOHAMED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

8 LOVERS LN
EAST LYME CT
06333-1516
US

V. Phone/Fax

Practice location:
  • Phone: 860-227-1280
  • Fax:
Mailing address:
  • Phone: 860-227-1280
  • Fax: 860-227-1280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number207L00000X
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: