Provider Demographics
NPI:1427057702
Name:MIR, TAHIR USMAN (MD)
Entity type:Individual
Prefix:
First Name:TAHIR
Middle Name:USMAN
Last Name:MIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2702
Mailing Address - Country:US
Mailing Address - Phone:724-463-1410
Mailing Address - Fax:724-463-1410
Practice Address - Street 1:7 S 5TH ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2702
Practice Address - Country:US
Practice Address - Phone:724-463-1410
Practice Address - Fax:724-463-1410
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037173L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1005099OtherGATEWAY
PA0007488170001Medicaid
P00038373OtherCHAMPUS
P002008OtherGATEWAY
MI46536Medicare ID - Type Unspecified
PA0007488170001Medicaid