MEDICARE: SALMAN MIRZA

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2025100903	MA

General Provider Information

NPI Number	:	1578403994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALMAN MIRZA

Provider Business Mailing Address
First Line	:	166 GRANT AVE
Second Line	:
City	:	MEDFORD
State	:	MA
Zip	:	02155-2765
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 GRANT AVE
Second Line	:
City	:	MEDFORD
State	:	MA
Zip	:	02155-2765
Country	:	US
Telephone Number	:	978-512-2699
Fax Number	:

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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Directions to “ SALMAN MIRZA ” Practice Location

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