Healthcare Provider Details

I. General information

NPI: 1710911268
Provider Name (Legal Business Name): MIRZA M BEG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 EAST AVE
LOCKPORT NY
14094-3201
US

IV. Provider business mailing address

294 EAST AVE
LOCKPORT NY
14094-3134
US

V. Phone/Fax

Practice location:
  • Phone: 716-514-5700
  • Fax:
Mailing address:
  • Phone: 904-482-1070
  • Fax: 904-482-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number140863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: