Provider / Organization | NPI | Date Certified |
---|---|---|
IMRAN AHMED MRIDHA | 1558970558 | 2020-07-24 |
Imran Ahmed Mridha is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1558970558. Registration indicates Imran Ahmed Mridha is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
Entity Type | Individual |
Provider Name | Imran Ahmed Mridha PA |
Practice Office Address | 75 KINGS HIGHWAY CUTOFF STE 3A FAIRFIELD, CT US |
Practice Office Telephone | 2037437264 |
Practice Office Fax | 2037923920 |
Mailing Address | 11350 MCCORMICK RD EXECUTIVE PLAZA 1, STE. 501 HUNT VALLEY, MD 210317958 US |
Business Telephone | 7039148000 |
Direct Messaging Address [] | [email protected] |
Code | Practice | License No State |
---|---|---|
363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | 5039
CT |