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General NPI Number Information
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NPI Number | 1063690691
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Entity Type | Individual
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Provider Name | TAHIRA F MIRZA M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 55 FOGG RD
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City | WEYMOUTH
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State | MA
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Zip | 02190-2432
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Country | US
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Telephone | 781-792-4121
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Fax | 781-878-6750
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Provider Business Mailing Address
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Address Line | 55 FOGG RD COASTAL MEDICAL ASSOCIATES
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City | SOUTH WEYMOUTH
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State | MA
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Zip | 02190-2432
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Country | US
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Telephone | 781-624-8000
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Fax | 781-878-6750
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036-119777
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 042481
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 4301072064
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 257617
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License Number State | MA
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