Basic Information
| Provider Information | |||||||||
| NPI: | 1538328869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAFIQUE | ||||||||
| FirstName: | MARYUM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 WILMINGTON W CHESTER PIKE STE 214 | ||||||||
| Address2: | |||||||||
| City: | CHADDS FORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193179007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443657246 | ||||||||
| FaxNumber: | 6103617956 | ||||||||
| Practice Location | |||||||||
| Address1: | 1197 AIRPORT RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199636418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443657246 | ||||||||
| FaxNumber: | 8445160080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | OS015320 | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 102774532-0002 | 05 | PA | MEDICAID | 102774532-0003 | 05 | PA | MEDICAID | 102774532-0001 | 05 | PA | MEDICAID |