Healthcare Provider Details

I. General information

NPI: 1306011259
Provider Name (Legal Business Name): MARYAM HADIASHAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MAPLE ST FL 4
REDWOOD CITY CA
94063-2057
US

IV. Provider business mailing address

901 MARSHALL ST FL 3
REDWOOD CITY CA
94063-2026
US

V. Phone/Fax

Practice location:
  • Phone: 650-299-2015
  • Fax:
Mailing address:
  • Phone: 650-299-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD169778
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number41054
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD169778
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA105164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: