Provider Demographics
NPI:1861460099
Name:HAMIRANI, MIRZA T (MD)
Entity type:Individual
Prefix:MR
First Name:MIRZA
Middle Name:T
Last Name:HAMIRANI
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 1:800 GRAND CENTRAL MALL
Mailing Address - Street 2:SUITE #9
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4100
Mailing Address - Country:US
Mailing Address - Phone:304-834-3970
Mailing Address - Fax:304-916-1871
Practice Address - Street 1:800 GRAND CENTRAL MALL
Practice Address - Street 2:SUITE #9
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4100
Practice Address - Country:US
Practice Address - Phone:304-834-3970
Practice Address - Fax:304-916-1871
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20965207RN0300X
OH35-08-1948-H207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110247849OtherRAILROAD MEDICARE
WV2004024-000Medicaid
OH2386403Medicaid
OH2386403Medicaid
110247849OtherRAILROAD MEDICARE
WV9331061Medicare PIN