MEDICARE: DR. NAUREEN AZAMALI MIRZA-GEORGE 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
1	207W00000X	Ophthalmology Physician	MT184366	PA
2	207W00000X	Ophthalmology Physician	MD434804	PA
3	207W00000X	Ophthalmology Physician	A112459	CA

General Provider Information

NPI Number	:	1508922592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAUREEN AZAMALI MIRZA-GEORGE MD

Provider Business Mailing Address
First Line	:	395 HICKEY BLVD
Second Line	:	FL 5
City	:	DALY CITY
State	:	CA
Zip	:	94015-2770
Country	:	US
Telephone Number	:	215-680-5571
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 CHRISTIAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-4321
Country	:	US
Telephone Number	:	215-680-5571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	01/24/2022

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