Healthcare Provider Details

I. General information

NPI: 1255863189
Provider Name (Legal Business Name): MARIYAM HASHMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE K201
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

740 S LIMESTONE STE K201
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-2509
  • Fax: 859-323-3499
Mailing address:
  • Phone: 859-218-2509
  • Fax: 859-323-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number66667
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1.065711-RES
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number58345
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: