Provider Demographics
NPI:1831351824
Name:BICKELL, MARYAM (DO)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:BICKELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARYAM
Other - Middle Name:
Other - Last Name:NAMDARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E LEHIGH AVE
Mailing Address - Street 2:TEMPLE EPISCOPAL CAMPUS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1012
Mailing Address - Country:US
Mailing Address - Phone:215-707-8483
Mailing Address - Fax:215-707-0726
Practice Address - Street 1:100 E LEHIGH AVE
Practice Address - Street 2:TEMPLE EPISCOPAL CAMPUS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1012
Practice Address - Country:US
Practice Address - Phone:215-707-8483
Practice Address - Fax:215-707-0726
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT0127452084P0800X
PAOS0160502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry