Healthcare Provider Details

I. General information

NPI: 1689644247
Provider Name (Legal Business Name): MIR-FERAYDOON MAHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N PICKAWAY ST
CIRCLEVILLE OH
43113-2409
US

IV. Provider business mailing address

12941 STONECREEK DR UNIT A
PICKERINGTON OH
43147-8424
US

V. Phone/Fax

Practice location:
  • Phone: 614-552-0061
  • Fax: 614-552-0168
Mailing address:
  • Phone: 614-552-0061
  • Fax: 614-552-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35-069429
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: