Provider Information for 1952857815
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MUSTANSAR MIR M.D
Sex: Male
NPI: 1952857815
Last Updated: 2022-08-16
Certification Date: 2022-08-16
Certification Date: 2022-08-16
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1952857815 | ||||||||||||||||
| Enumeration Date | 2016-08-31 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-8082 United States Phone: 860-679-4165 | Fax:860-676-3413 | ||||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVENUE FARMINGTON, CT 06030 United States Phone: 860-679-4477 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 277 PLEASANT ST | ||||||||||||||||
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