Basic Information
| Provider Information | |||||||||
| NPI: | 1639354517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIR | ||||||||
| FirstName: | HAFSA | ||||||||
| MiddleName: | S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64442 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102258000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 827 LINDEN AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102258000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D71148 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | P21815 | MD | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | D71148 | MD | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 554215400 | 05 | MD | MEDICAID | S062-0558 | 01 | MD | CAREFIRST BC/BS | OTHER |