Provider Demographics
NPI:1861522005
Name:EID, MARIAM A (MD)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:A
Last Name:EID
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2600 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3055
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7518
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007003798207V00000X
IN01067785A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200981380Medicaid
IN000000665933OtherANTHEM PROVIDER NUMBER
MO# PENDINGMedicaid
INM400017586Medicare PIN
MO# PENDINGMedicare UPIN
IN200981380Medicaid
IN000000665933OtherANTHEM PROVIDER NUMBER