Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD426729 | PA |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD426729 | PA |
NPI | 1295925915 |
---|---|
Provider Name | Maryam Y Naim |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4399 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2007 |
Last Update Date | 10/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1022171900001 | (05) | PA |
125797EMD | MEDICARE PTAN (01) | PA |