Basic Information
| Provider Information | |||||||||
| NPI: | 1134557671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOHAMMAD ZADEH | ||||||||
| FirstName: | MARYAM | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 W 7TH ST | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217014506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405663300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1310 SOUTHERN AVE SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200324623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027412302 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2013 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | AC001744 | MD | N | Allopathic & Osteopathic Physicians | Hospitalist | 363L00000X | RN1049834 | DC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | AC001744 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.