Basic Information
| Provider Information | |||||||||
| NPI: | 1619135571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHMUD | ||||||||
| FirstName: | MARIAM | ||||||||
| MiddleName: | RAHMAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 803 EVERGREEN CT | ||||||||
| Address2: | |||||||||
| City: | NORTH WALES | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194542098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153619171 | ||||||||
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| Practice Location | |||||||||
| Address1: | FRONT ST AT ERIE AVENUE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154275000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2008 | ||||||||
| LastUpdateDate: | 05/28/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MT-183731 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.