Individual
IMRAN A MIRZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1132 COOPER ST, DEPTFORD, NJ 08096-3014
(856) 848-8060
Mailing address
PO BOX 69, MICKLETON, NJ 08056-0069
(856) 381-9598
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA08024700
NJ
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD431989
PA
261QU0200X
Urgent Care Clinic/Center
25MA08024700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019810230001
—
PA
05
—
1019810230002
—
PA
01
—
1980195
BS HIGHMARK
PA
Enumeration date
07/04/2006
Last updated
09/22/2014
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