Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OS019656 | PA |
N | 111NI0900X | Internist | OS019656 | PA |
N | 207RG0300X | Geriatric Medicine | OS019656 | PA |
NPI | 1023490448 |
---|---|
Provider Name | Maryam Farooq |
First Address | Willow Grove, PA 19090-1225 |
Second Address | Lower Gwynedd, PA 19002-2501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2015 |
Last Update Date | 06/12/2019 |