Individual
DR. SHAHIN MICHAEL MIRMANESH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12000 LINCOLN DR W, SUITE 405, MARLTON, NJ 08053-3402
(856) 985-0203
(856) 985-0010
Mailing address
1 STAR SPLITTER CT, VOORHEES, NJ 08043-9517
(856) 985-0203
(856) 985-0010
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA06992000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8584800
—
NJ
Enumeration date
07/06/2006
Last updated
09/23/2010
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