Basic Information
| Provider Information | |||||||||
| NPI: | 1023490448 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAROOQ | ||||||||
| FirstName: | MARYAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 MARYLAND RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154814143 | ||||||||
| FaxNumber: | 2154816790 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 N BETHLEHEM PIKE | ||||||||
| Address2: | |||||||||
| City: | LOWER GWYNEDD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190022501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156432119 | ||||||||
| FaxNumber: | 2156433568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2015 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS019656 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | OS019656 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 208M00000X | OS019656 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.