Provider Demographics
NPI:1861606436
Name:MARIAM, UZMA (MD)
Entity type:Individual
Prefix:
First Name:UZMA
Middle Name:
Last Name:MARIAM
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 1:41 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2668
Mailing Address - Country:US
Mailing Address - Phone:610-252-8037
Mailing Address - Fax:610-252-1861
Practice Address - Street 1:41 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2657
Practice Address - Country:US
Practice Address - Phone:610-252-8037
Practice Address - Fax:610-252-1861
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432681207Q00000X
NJ25MA08294700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0166154Medicaid
NJ126258Medicare PIN
NJ0166154Medicaid