Provider Demographics
NPI:1538328869
Name:RAFIQUE, MARYUM (DO)
Entity type:Individual
Prefix:DR
First Name:MARYUM
Middle Name:
Last Name:RAFIQUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BECKS WOODS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3835
Mailing Address - Country:US
Mailing Address - Phone:855-932-7426
Mailing Address - Fax:833-392-7426
Practice Address - Street 1:100 BECKS WOODS DR STE 201
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3835
Practice Address - Country:US
Practice Address - Phone:855-932-7426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECS00111742081P2900X
PAOS015320208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102774532-0003Medicaid
PA102774532-0002Medicaid
PA102774532-0001Medicaid
PA261837MWAMedicare PIN