Provider Demographics
NPI:1962438861
Name:AVRAM, MIRIT (MD)
Entity type:Individual
Prefix:
First Name:MIRIT
Middle Name:
Last Name:AVRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 E CALVADA BLVD
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5804
Mailing Address - Country:US
Mailing Address - Phone:775-727-6400
Mailing Address - Fax:775-727-7543
Practice Address - Street 1:2210 E CALVADA BLVD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5804
Practice Address - Country:US
Practice Address - Phone:775-727-6400
Practice Address - Fax:775-727-7543
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11604207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV11604OtherNV LICENSE
NV1962438861Medicaid
NV13891OtherCONTROLLED SUBSTANCE
NV13891OtherCONTROLLED SUBSTANCE
NVV111050Medicare PIN