Provider Demographics
NPI:1902980352
Name:MIRSEN, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:MIRSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-342-2445
Mailing Address - Fax:856-964-0504
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 215 (NEUROLOGY)
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2445
Practice Address - Fax:856-964-0504
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA545292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010003879OtherAMERICHOICE
P440700OtherOXFORD
7808502OtherCIGNA
3K6143OtherHEALTHNET
1024720OtherHORIZON NJ HEALTH
1243169OtherUNITED HEALTHCARE
567399OtherAMERIHEALTH PPO
0388541000OtherAMERIHEALTH, KEYSTONE, IBC
0518267OtherAETNA
NJ0651800Medicaid
110084266OtherRR MEDICARE
13517OtherUNIVERSITY HEALTH PLAN
E62059Medicare UPIN
NJ567399Medicare PIN