Provider Demographics
NPI:1902970270
Name:MIRZA, REHMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:REHMAN
Middle Name:
Last Name:MIRZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 AUTH PL
Mailing Address - Street 2:#575
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4223
Mailing Address - Country:US
Mailing Address - Phone:301-899-0380
Mailing Address - Fax:301-899-0381
Practice Address - Street 1:4710 AUTH PL
Practice Address - Street 2:#575
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4223
Practice Address - Country:US
Practice Address - Phone:301-899-0380
Practice Address - Fax:301-899-0381
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02057111N00000X
VA0104555921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor