Healthcare Provider Details

I. General information

NPI: 1265435465
Provider Name (Legal Business Name): MARYAM JABERI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 WILKENS AVE STE 410
BALTIMORE MD
21229-5074
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 443-574-8500
  • Fax: 410-719-0094
Mailing address:
  • Phone: 410-955-5000
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0062522
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: