Healthcare Provider Details

I. General information

NPI: 1073575239
Provider Name (Legal Business Name): MARIAM M BASMA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

6 MAUREEN WAY
BEAR DE
19701-6338
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-6842
  • Fax:
Mailing address:
  • Phone: 302-836-9476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0000224
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: