Provider Demographics
NPI:1548536691
Name:DIAB, MARIAM AHMAD (MD)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:AHMAD
Last Name:DIAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 WOOSTER RD
Mailing Address - Street 2:515
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-4174
Mailing Address - Country:US
Mailing Address - Phone:216-482-1087
Mailing Address - Fax:
Practice Address - Street 1:2351 EAST 22ND STREET
Practice Address - Street 2:ST VINCENT CHARITY MEDICAL CENTRE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115
Practice Address - Country:US
Practice Address - Phone:216-482-1087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.127078207P00000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine