Provider Demographics
NPI:1124822374
Name:MIRZA, IRSHAD AHMAD (MD)
Entity type:Individual
Prefix:
First Name:IRSHAD AHMAD
Middle Name:
Last Name:MIRZA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1102
Mailing Address - Country:US
Mailing Address - Phone:347-878-6236
Mailing Address - Fax:
Practice Address - Street 1:37 ALBION ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1102
Practice Address - Country:US
Practice Address - Phone:347-878-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPENDING207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine