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NPI Code Detail

MEDICARE: NATASHA MIRZA MD

MEDICARE:   NATASHA  MIRZA  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207YX0007XPlastic Surgery within the Head & Neck (Otolaryngology) PhysicianMD050143LPA
2207Y00000XOtolaryngology PhysicianMD050143LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508895020
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATASHA MIRZA MD
Provider Business Mailing Address
First Line : 3400 CIVIC CENTER BLVD
Second Line : SOUTH PAVILION, 3RD FLOOR
City : PHILADELPHIA
State : PA
Zip : 19104-5127
Country : US
Telephone Number : 215-662-2777
Fax Number : 215-662-4613
Provider Business Practice Location Address
First Line : 3400 CIVIC CENTER BLVD
Second Line : SOUTH PAVILION, 3RD FLOOR
City : PHILADELPHIA
State : PA
Zip : 19104-5127
Country : US
Telephone Number : 215-662-2777
Fax Number : 215-662-4613
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 03/11/2026

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