Healthcare Provider Details

I. General information

NPI: 1033121843
Provider Name (Legal Business Name): RUQAYYA MIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 PHILADELPHIA RD 204
BALTIMORE MD
21237-4329
US

IV. Provider business mailing address

6 HOUNDSTOOTH CT
OWINGS MILLS MD
21117-1503
US

V. Phone/Fax

Practice location:
  • Phone: 410-687-9969
  • Fax: 410-687-6696
Mailing address:
  • Phone: 410-687-9969
  • Fax: 410-687-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0026155
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: