Basic Information
| Provider Information | |||||||||
| NPI: | 1871506311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIR | ||||||||
| FirstName: | ZULFIQAR | ||||||||
| MiddleName: | ALI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 BROCKTON AVE | ||||||||
| Address2: | INTERNAL MEDICINE | ||||||||
| City: | ABINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023512186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818781700 | ||||||||
| FaxNumber: | 7818714375 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 CENTRE ST | ||||||||
| Address2: | SIGNATURE MEDICAL GROUP | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088940400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 06/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | E-2586 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 233668 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2144191 | 05 | MA | MEDICAID |